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

Abstract

Background Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series.Questions/purposes (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design? Methods Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012. During this time period, all patients undergoing primary THA by this surgeon received the same cementless short titanium taper stem. Seven patients (eight hips) died and five patients (five hips) were lost to followup, leaving 226 patients (248 hips) with a mean followup of 3 years (range, 2-5 years). Patients rated their thigh pain during activity or rest at final followup on a 10-point visual analog scale. Harris hip scores (HHS) were obtained at every clinic appointment. Thigh pain was evaluated at the final followup or by contacting the patient by phone. Radiographs were evaluated for boneimplant fixation, bone remodeling, and osteolysis. An attempt was made to correlate thigh pain with patient demographics, implant specifications, or radiographic findings. Results Seventy-six percent of hips (180 of 238) had no thigh pain, 16% of hips (37 of 238) had mild thigh pain, and 9% (21 of 238) had moderate or severe thigh pain. Preoperatively, mean HHS was 47 (SD, 16) and at last followup, mean HHS was 88 (SD, 13). There were two femoral revisions, one for severe thigh pain and the other for infection. All but two components demonstrated bone ingrowth fixation (99%). Femoral stress shielding was mild in 64% of hips (135 of 212), moderate in 0.5% (one of 212), and severe in no hips. There is an inverse linear

Uncemented short stems in primary total hip arthroplasty

“…In two studies including 415 hips, 72 , 73 the mean intra-operative peri-prosthetic fracture rate was 0.5% (0% to 1.6%) and the coronal stem alignment was valgus and varus in 20.5% and 7.5% of the hips, respectively. Amendola et al 73 also investigated the onset of cortical hypertrophy and femoral stress shielding, reporting an incidence of 2% and 64.5%, respectively. On the other hand, Albers et al 72 investigated the onset of stem subsidence, reporting an incidence of 39.8% with an average of 1.04 mm (0.5 to 5).…”

“…The Tri-Lock stem demonstrated a mean survivorship of 99.5% (99.2% to 100%) with femoral revision as the endpoint, at a mean follow-up of 3.4 years (2.3 to 5) in 475 hips. 71 – 73 The mean HHS was 86.5 points (85 to 88) at the final follow-up assessment, while the mean incidence of thigh pain was 12.3% (1.6% to 16%). In two studies including 415 hips, 72 , 73 the mean intra-operative peri-prosthetic fracture rate was 0.5% (0% to 1.6%) and the coronal stem alignment was valgus and varus in 20.5% and 7.5% of the hips, respectively.…”

“…71 – 73 The mean HHS was 86.5 points (85 to 88) at the final follow-up assessment, while the mean incidence of thigh pain was 12.3% (1.6% to 16%). In two studies including 415 hips, 72 , 73 the mean intra-operative peri-prosthetic fracture rate was 0.5% (0% to 1.6%) and the coronal stem alignment was valgus and varus in 20.5% and 7.5% of the hips, respectively. Amendola et al 73 also investigated the onset of cortical hypertrophy and femoral stress shielding, reporting an incidence of 2% and 64.5%, respectively.…”

Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem

“…After analysing 217 hips operated with a cementless short titanium taper stem, Amendola et al evidenced that around 23% of patients suffered from thigh pain (with 9% describing moderate to severe pain) at an average of 3-year follow-up [ 1 ]. Although finding mild stress shielding in 64% of cases and varus alignment in 8%, the authors could not correlate them statistically with pain or risk of revision.…”

“…However, whether short stems can achieve similar clinical and radiographic outcomes to that of standard length stems in the long-term and also maintain a low frequency of thigh pain is still a matter of controversy. Recent reports have emphasized on mild to excruciating thigh pain developing after short-stem total hip arthroplasty (THA) [ 1 , 2 ].…”