Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

Abstract

Background The application of short femoral stems is partially restricted in revision surgery. This study will demonstrate the therapeutic effect and unsuitable situation for short stem revision. Methods Demographic characteristics of all patients were recorded in detail (Table 1). Anteroposterior view radiographic examinations of proximal femur are necessary before and after the operation for patients. The primary outcome of interest was the survival rate of the femoral stem at the final follow-up. Risk factors for failure were also investigated. The secondary outcomes of interest included the Harris hip score, excellent to good rate and incidence of complications. The Mann–Whitney U test was performed for comparisons between continuous variables. The chi-square test was performed for comparisons between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and the failure of revision surgery. Results A total of 381 patients with short stems were retrospectively reviewed. There were 188 males and 193 females. The average age and body mass index before revision surgery were 58.85 ± 13.46 years and 23.72 ± 3.40 kg/m2, respectively. The mid-term survival rate of the short femoral component was 94.23%. The prognosis and complications of patients between the two groups were compared. There was no significant difference between the two groups in the Harris score, complication incidence or survival rate of the femoral component. The strongest risk factor in this study was intraoperative periprosthetic femoral fracture during revision surgery (HR = 5.477, 95% CI = 2.156–13.913). Conclusion Three risk factors for failure were identified: ageing, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, a short femoral stem should be implanted in patients with these risk factors with additional caution.

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

“…Revision with a short stem is a controversial procedure, supported by limited clinical evidence from the literature and few expert opinions [34,35,37]. Similar to conventional stems, it is very important to discriminate the correct short stem type and the femoral bone loss.…”

“…Similar to conventional stems, it is very important to discriminate the correct short stem type and the femoral bone loss. Ideally, many revisions with a supportive proximal femur can be managed with a shortened tapered conventional stem with a meta-diaphyseal anchorage [34]. Short stem revisions could be planned using the Casella's classification for proximal bone defects in conservative arthroplasties [7].…”

“…A failed resurfacing arthroplasty leaving a supportive medial neck may be revised even with a neck-retaining short stem [7]. All the other cases may benefit from shortened tapered con-ventional implants, which can be used even in more severe cases, with a minor diaphyseal bone violation (with a little stem oversizing) [7,34]. A "downsizing" from longer stems should be carefully evaluated and adopted in very selected cases [35,37].…”

“…It appears that the possible indications are distal bone/cement plug, retained hardware or bone remodeling in which a femoral osteotomy/transfemoral approach is not feasible/desirable [35,37]. Meta-diaphyseal bone stock should be assessed and bone grafting can be performed if necessary [34]. Stress risers in the presence of thin cortices should be avoided [34,35].…”

“…Liu et al described a sizeable cohort of 381 revisions where short stems (Trilock, DePuy, Warsaw, IN, USA) were adopted for femoral defects graded up to Paprosky IIIA. Bone grafting was performed as needed [34]. The mid-term survival rate of revisions using short stems was 94.5%.…”