Revision rate after short-stem total hip arthroplasty

Abstract

Background and purposeThe aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty.Materials and methodsWe conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as “collum”, “partial collum”, or “trochanter-sparing”.Results and InterpretationWe found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on “partial collum” and “trochanter-sparing” stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from “collum stem” studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

“…The use of short femoral stems has increased over the last decade [49]. Although the preservation of metaphyseal bone and ease of insertion may seem intuitive, what remains unresolved with short stem designs is whether they can achieve comparable functional and radiographic results to standard length stems in the long term and also maintain a low frequency of thigh pain.…”

“…Despite increased use of short femoral stems and excellent short-to midterm results, there are still relatively little data on individual short stem designs [49]. It is remains unclear whether all cementless short femoral stem designs are able to achieve comparable long-term clinical results to traditional stems while also achieving the goals of preserving metaphyseal bone and limiting thigh pain.…”

“…In addition, shorter broach-only stems can provide easier insertion, especially through smaller direct anterior approaches [18,27,36,45]. Earlier studies have shown that short stems have similar risks of revision as well as comparable fixation and clinical outcomes to conventional length stems [2,40,49].…”

CORR Insights®: Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years

“…Most studies covering short-stem hip arthroplasty are Level 4 case series [2]. Many of these studies were performed by hip surgeons who specialize in THA, which can result in an expertise bias.…”

“…Although shortstem designs are not a new concept [1,2], there has been a growing interest in utilizing less-invasive techniques. This trend illustrates the progression towards bone-and tissue-sparing THA.…”