Uncemented short stems in primary total hip arthroplasty

Loppini, Mattia; Grappiolo, Guido

doi:10.1302/2058-5241.3.170052

Cited by 57 publications

(56 citation statements)

References 95 publications

(99 reference statements)

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“…Therefore, within this population, an effective THA should aim in preserving the metaphyseal bone, providing feasible femoral revision options and allowing easier implantation with less invasive procedures. Although conventional, uncemented stems have shown excellent implant survivorship and long-term outcomes [5], they might be associated with a reduction of trochanteric bone stock and thigh pain due to impingement with the diaphyseal femoral cortex [6]. Short cementless femoral components were developed to preserve metaphyseal bone through proximal load transfer and facilitate the femoral stem implantation through minimally invasive approaches.…”

Section: Introductionmentioning

confidence: 99%

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Schaer

Finsterwald

Holweg

et al. 2019

BMC Musculoskelet Disord

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BackgroundEarly femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems.MethodsIn this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA).ResultsAverage stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures.ConclusionsThe examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.

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Section: Introductionmentioning

confidence: 99%

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Schaer

Finsterwald

Holweg

et al. 2019

BMC Musculoskelet Disord

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“…As patients receiving THA are increasingly (biologically) younger and active, the development of less invasive approaches and bone preserving solutions has been a key focus during the last decade [8,9]. HR has emerged as a promising way of sparing bone, while retaining the biomechanics of the hip joint and potentially allowing a facilitated revision, if necessary [10,11].…”

Section: Introductionmentioning

confidence: 99%

Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now?

et al. 2019

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Background The number of total hip arthroplasties (THA) is rising in many industrialized nations. At the same time, the evidence regarding different types of prostheses and fixation techniques is constantly evolving. Therefore, this study aimed to analyze changes in THA by these advancements during the last decade. Methods A retrospective analysis of data provided by the Federal Statistical Office of Germany from 2007 to 2016 was conducted using codes from the German procedure classification system and associated International Statistical Classification of Diseases and Related Health Problems codes. THA procedures were evaluated according to diagnoses, sex, and age of patients, along with the distribution of different prosthesis types. Additionally, changes in these parameters over time were analyzed. Results From 2007 to 2016 a total of 2 157 041 primary THA procedures were performed in Germany, with an increase of 14.4% over this period. Overall, cementless standard THA (STHA) was used most frequently (50.0%), followed by hybrid variants (18.8%), hemiarthroplasties (15.9%), cemented standard THA (cSTHA; 9.2%), cementless short-stem THA (ssTHA; 4.8%), and hip resurfacing (HR; 0.9%) techniques. During the study period, the number of cSTHA and HR decreased significantly, whereas the use of STHA and ssTHA rose substantially, with a significantly higher application of these procedures in the elderly population. While osteoarthritis of the hip joint was the main indication for THA, several procedure-specific differences were identified. Conclusion The present data clearly demonstrate an increase in the use of cementless fixation for THA in Germany during the last decade and document a rise in ssTHA in recent years with, in contrast, the use of HR decreasing to a minimum.

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“…In this manner, the risk of bleeding due to incision of the quadratus of the femur, which is in close contact with the circumflex arteries anastomosis, can be reduced. Moreover, the use of a short stem maintains greater bone stock and significantly reduces bleeding compared to the use of more invasive straight stems [19–22].…”

Section: Discussionmentioning

confidence: 99%

One-staged combined hip and knee arthroplasty: retrospective comparative study at mid-term follow-up

et al. 2019

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Background To date, few knowledge is available about safety and effectiveness of one-staged combined hip and knee arthroplasty. The aim of our study was to evaluate, in a comparative fashion, complications and outcomes in patients who underwent one-staged hip and knee arthroplasty. Methods Forty-two patients were enrolled and allocated into two groups of 21 patients each: one-staged hip and knee arthroplasty (group A) and two-staged hip and knee arthroplasty (group B). The follow-up averaged 50.2 months. Postoperative complications and implant survivorship were assessed prospectively. Outcomes were evaluated with Harris Hip score (HSS), Western Ontario Mc-Ministry score for the hip (h-WOMAC), Knee Society score (KSS), and Western Ontario Mc-Ministry knee score (k-WOMAC). Hip and knee range of motion (ROM) were measured both preoperatively and at the last follow-up. Results Two (9.5%) patients in group A and three (14.3%) patients in group B developed complications ( P = 0.8). Although a significant decrease in postoperative haemoglobin (Hgb) values was found in group A patients during the hospital stay, no differences in blood transfusions were found ( P = 0.8). No significant differences were found comparing clinical-functional outcomes between the two groups, while a significant reduction of hospital length of stay was shown in group A patients. Conclusions One-staged combined hip and knee arthroplasty could be considered in patients with co-existing severe hip and knee osteoarthritis, providing similar complications and mid-term outcomes of two-staged procedures. However, the reproducibility safety and reliability of these procedures should be confirmed in prospective comparative randomised trials with more numerous patients. Trial registration Retrospectively registered

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Uncemented short stems in primary total hip arthroplasty

Cited by 57 publications

References 95 publications

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now?

One-staged combined hip and knee arthroplasty: retrospective comparative study at mid-term follow-up

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