Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem

Abstract

Purpose: The occurrence of thigh pain following cementless total hip arthroplasty (THA) may be dependent on multiple factors, which may differ with design of the prosthesis. Thus, this study aimed to investigate the frequency of thigh pain following cementless THA using a short, tapered-wedge stem to identify risk factors for thigh pain.Methods: This retrospective cohort study analysed 222 joints of patients who underwent THA with a short, tapered-wedge stem. Thigh pain was evaluated using a questionnaire during each follow-up visit and the clinical and radiographic assessments were compared.Results: Thigh pain occurred in 37 patients (16.7%) during the follow-up period. The pain started 2-24 months after THA. Multivariate analysis demonstrated that higher University of California, Los Angeles, activity rating [odds ratio 2.3; 95% confidence interval (CI) 1.3-4.0]; Dorr type C femoral bone shape (odds ratio 14.7; 95% CI 2.0-106.3); and stem tip-cortical bone contact (odds ratio 22.8; 95% CI 4.1-126.7) were significant risk factors of thigh pain following THA. Post-operatively, cortical hypertrophy at Gruen zone 4 was significantly found in patients with thigh pain (p-value= 0.032).Conclusion: Risk factors of pain following THA with short, tapered-wedge stem were high activity level, Dorr type C femoral bone shape, and stem tip contacting the distal bone surface. Moreover, post-operative cortical hypertrophy at the distal stem tip significantly increased the incidence of thigh pain. Therefore, we must pay attention to the aforementioned factors to avoid post-operative thigh pain when using a short, tapered-wedge stem.

Comparing postoperative outcomes of two fully hydroxyapatite-coated collarless stems in total hip arthroplasty through propensity score matching analysis with 2 years follow-up

“…On the other hand, Vidalain JP reported that thigh pain was observed in only 2 out of 127 hips at 20 years postoperatively using the Corail stem, and the rate was similar to the results of the present study. In addition, although cortical hypertrophy, where the cortical bone becomes thicker when stress is concentrated at the distal part of the stem has been reported to correlate to thigh pain in THA using short tapered-wedge stem 18 , no cortical hypertrophy was observed with either Corail or Hydra stem in this study. These results may be considered to be in line with the concept of the Corail type fully HA-coated stems, where the load is distributed on the entire body of the stem.…”

Hydroxyapatite-coated compaction short stem represents a characteristic pattern of peri-prosthetic bone remodelling after total hip arthroplasty

“…The occurrence of thigh pain impairs the restoration of hip function, occasionally resulting in revision surgery; however, this is a common complication following THA (21,22). Thigh pain was previously reported in 16.7% of 222 patients after THA using the short tapered-wedge stem (23), and thigh pain was reported by 18.9% of 95 patients with the short tapered-wedge stem in this study. In contrast, thigh pain did not occur in 133 patients with the conventional full HA compaction stem at the 11.5-year follow-up (24), and 83% of the patients were completely symptom-free at the 20-year follow-up (25).…”

Osteoanabolic Treatment with Teriparatide for Pathological Stress Transfer After Total Hip Arthroplasty

“…Symptoms caused by pathological load transfer around the tip of the stem are ultimately an exclusion diagnosis after other causes have been ruled out carefully. On conventional radiographs, pathological load transfer can be postulated when cortical hypertrophy is noted around the tip of the stem in combination with proximal stress shielding 10,26,27 . A bone scan might be used as an additional tool to further investigate this condition.…”