Downsizing in total hip arthroplasty. A short stem as a revision implant

Abstract

Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.

Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty

“…Coutandin et al recently introduced the concept of downsizing the femoral component in revision THA in a subset of cases using the same short stem as in the present study, and reported satisfying clinical outcomes and no major complications [ 15 ]. Another case series investigated the outcomes of revision surgery of failed hip resurfacing arthroplasty using short-stem THA.…”

“…Short-stem THA has gained popularity over the last decade and is now well established in most of Europe [ 14 ]. It focuses on metaphyseal anchorage and thus offers potential advantages regarding bone preservation and the prevention of stress shielding, and it provides favourable conditions for revision without altering the basic concepts of conventional THA [ 8 , 15 ]. Encouraging results in recent years have broadened the range of indications for short-stem THA [ 16 – 18 ].…”

“…Encouraging results in recent years have broadened the range of indications for short-stem THA [ 16 – 18 ]. Although considered off-label use, the use of cementless short stems in assorted cases of revision surgery has been reported recently [ 15 , 19 , 20 ].…”

Zementfreie Kurzschaftprothesen in der Hüftendoprothetik: Möglichkeiten und Limits

“…In individual cases in which the diaphyseal isthmus is displaced or the medullary canal is asymmetrically deformed, our clinical experience has shown that even loosened straight stems can be revised using a short stem in some patients and that 'downsizing' can be performed in selected individual cases (▶ Fig. 8) [16].…”

“…Short stems with encouraging mid-and longterm clinical and radiological outcomes have become a genuine alternative to standard stems [1,10,11,12,13]. Moreover, the good results and experiences have expanded the indication spectrum [6,14,15,16]. However, these implants also have limitations, and, in addition to the requirement of a learning curve for the implantation technique, require distinct patient selection.…”