Primary Total Hip Arthroplasty With Short Stems in Patients Under 20 Years of Age
Article Sidebar
Published:
Oct 24, 2022
Keywords:
Total hip arthroplasty, total hip replacement, pediatric patients, young adults
Main Article Content
Abstract
Introduction: To our knowledge, there is no published literature on the outcomes of short-stem total hip arthroplasty (THA) in patients under 20 years old. This study aimed to analyze clinical, radiological, and functional outcomes in patients under 20 years of age undergoing THA with a short uncemented 2B femoral stem.
Materials and Methods: We carried out a retrospective study of 13 patients (16 THAs) treated between January 2006 and January 2021. The mean age and BMI were 16.5±2.5 years and 22.74±4.06 kg/m2, respectively. The mean follow-up was 43.3 months (range 12-128, SD ± 33.45). Surgical indications, as wellas functional and radiologic outcomes, were analyzed. Implant survival was calculated with the Kaplan-Meier estimate.
Results: The predominant indication was avascular necrosis (9/16 hips [56%]), of which 66% were associated with prolonged use of corticosteroids. Eight (50%) of the cases had undergone surgeries before the THA. The Harris hip score improved significantly from 33±16.5 to 94±5.6 (p<0.001). Ten (76%) patients required assistive devices to walk preoperatively, and no patient required them at the end of follow-up. Radiolucency was evident in one acetabular component, without clinical implications. There were no signs of femoral component loosening. The implant survival was 100% at the last follow-up.
Conclusions: Short stems in primary THAs in patients under 20 years of age with advanced hip osteoarthritis showed clinical, functional, and radiological outcomes comparable to those previously reported in the literature for conventional stems, with the particularity of being less invasive and sparing femoral bone stock.
Materials and Methods: We carried out a retrospective study of 13 patients (16 THAs) treated between January 2006 and January 2021. The mean age and BMI were 16.5±2.5 years and 22.74±4.06 kg/m2, respectively. The mean follow-up was 43.3 months (range 12-128, SD ± 33.45). Surgical indications, as wellas functional and radiologic outcomes, were analyzed. Implant survival was calculated with the Kaplan-Meier estimate.
Results: The predominant indication was avascular necrosis (9/16 hips [56%]), of which 66% were associated with prolonged use of corticosteroids. Eight (50%) of the cases had undergone surgeries before the THA. The Harris hip score improved significantly from 33±16.5 to 94±5.6 (p<0.001). Ten (76%) patients required assistive devices to walk preoperatively, and no patient required them at the end of follow-up. Radiolucency was evident in one acetabular component, without clinical implications. There were no signs of femoral component loosening. The implant survival was 100% at the last follow-up.
Conclusions: Short stems in primary THAs in patients under 20 years of age with advanced hip osteoarthritis showed clinical, functional, and radiological outcomes comparable to those previously reported in the literature for conventional stems, with the particularity of being less invasive and sparing femoral bone stock.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Buljubasich, M., Kohan, S., Salagoity, F., Comba, F., Zanotti, G., Slullitel, P. A., & Buttaro, M. A. (2022). Primary Total Hip Arthroplasty With Short Stems in Patients Under 20 Years of Age. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 636-644. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1599
Section
Clinical Research
Copyright (c) 2022 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Hamadouche M, Kerboull L, Meunier A, Courpied JP, Kerboull M. Total hip arthroplasty for the treatment of
ankylosed hips: a five to twenty-one-year follow-up study. J Bone Joint Surg Am 2001;83(7):992-8. https://doi.org/10.2106/00004623-200107000-00003
2. Strathy GM, Fitzgerald RH. Total hip arthroplasty in the ankylosed hip. A ten-year follow-up. J Bone Joint Surg Am 1988;70(7):963-6. PMID: 3403586
3. Polkowski GG, Callaghan JJ, Mont MA, Clohisy JC. Total hip arthroplasty in the very young patient. J Am Acad
Orthop Surg 2012;20(8):487-97. https://doi.org/10.5435/JAAOS-20-08-487
4. Tsukanaka M, Halvorsen V, Nordsletten L, EngesæTer IØ, EngesæTer LB, Marie Fenstad A, et al. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop 2016;87(5):479-84. https://doi.org/10.1080/17453674.2016.1212180
5. Singsen BH, Isaacson AS, Bernstein BH, Patzakis MJ, Kornreich HK, King KK, et al. Total hip replacement in
children with arthritis. Arthritis Rheum 1978;21(4):401-6. https://doi.org/10.1002/art.1780210401
6. Ruddlesdin C, Ansell BM, Arden GP, Swann M. Total hip replacement in children with juvenile chronic arthritis. J
Bone Joint Surg Br 1986;68(2):218-22. https://doi.org/10.1302/0301-620X.68B2.3958006
7. Clohisy JC, Oryhon JM, Seyler TM, Wells CW, Liu SS, Callaghan JJ, et al. Function and fixation of total hip
arthroplasty in patients 25 years of age or younger. Clin Orthop Relat Res 2010;468(12):3207-13. https://doi.org/10.1007/s11999-010-1468-4
8. Kutzner KP, Freitag T, Donner S, Kovacevic MP, Bieger R. Outcome of extensive varus and valgus stem
alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA. Arch Orthop Trauma Surg 2017;137(3):431-9. https://doi.org/10.1007/s00402-017-2640-z
9. Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip
arthroplasty. A comparative study. Int Orthop 2017;41(7):1347-53. https://doi.org/10.1007/s00264-016-3365-2
10. Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. A short tapered stem reduces intraoperative
complications in primary total hip arthroplasty. Clin Orthop Relat Res 2012;470(2):450-61. https://doi.org/10.1007/s11999-011-2068-7
11. Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014;96(20):1742-52. https://doi.org/10.2106/JBJS.M.00780
12. Woolson ST, Harris WH. A method of intraoperative limb length measurement in total hip arthroplasty. Clin Orthop Relat Res 1985;(194):207-10. PMID: 3978918
13. Buttaro MA, Slullitel PA, Zanotti G, Comba FM, Piccaluga F. Is a short stem suitable for patients with hip
dysplasia? A report on technical problems encountered during femoral reconstruction. Hip Int 2018;28(3):315-23.
https://doi.org/10.5301/hipint.5000562
14. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am
1954;36-A(3):451-75. PMID: 13163078
15. Tönnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dysplasia (author’s transl)]. Z Orthop Ihre Grenzgeb 1979;117(5):808-15. PMID: 549339
16. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993;14(3):231-42. https://doi.org/10.1016/8756-3282(93)90146-2
17. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
18. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
19. Loudon JR, Charnley J. Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br 1980;62-B(4):450-3. https://doi.org/10.1302/0301-620X.62B4.7430222
20. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
21. Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty.
Orthopedics 2015;38(3 Suppl):S6-13. https://doi.org/10.3928/01477447-20150215-50
22. Buttaro M, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Preservación ósea femoral con tallos cortos de fijación cervicometafisaria: Estudio radiográfico comparativo con tallos no cementados de fijación metafisaria. Rev Asoc Argent Ortop Traumatol 2014;79(4):232-6. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-74342014000400006&lng=es
23. Rainer W, Shirley MB, Trousdale RT, Shaughnessy WJ. The open triradiate cartilage: how young is too young for total hip arthroplasty? J Pediatr Orthop 2021;41(9):e793-9. https://doi.org/10.1097/BPO.0000000000001940
24. Bessette BJ, Fassier F, Tanzer M, Brooks CE. Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up. Can J Surg 2003;46(4):257-62. PMID: 12930101
ankylosed hips: a five to twenty-one-year follow-up study. J Bone Joint Surg Am 2001;83(7):992-8. https://doi.org/10.2106/00004623-200107000-00003
2. Strathy GM, Fitzgerald RH. Total hip arthroplasty in the ankylosed hip. A ten-year follow-up. J Bone Joint Surg Am 1988;70(7):963-6. PMID: 3403586
3. Polkowski GG, Callaghan JJ, Mont MA, Clohisy JC. Total hip arthroplasty in the very young patient. J Am Acad
Orthop Surg 2012;20(8):487-97. https://doi.org/10.5435/JAAOS-20-08-487
4. Tsukanaka M, Halvorsen V, Nordsletten L, EngesæTer IØ, EngesæTer LB, Marie Fenstad A, et al. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop 2016;87(5):479-84. https://doi.org/10.1080/17453674.2016.1212180
5. Singsen BH, Isaacson AS, Bernstein BH, Patzakis MJ, Kornreich HK, King KK, et al. Total hip replacement in
children with arthritis. Arthritis Rheum 1978;21(4):401-6. https://doi.org/10.1002/art.1780210401
6. Ruddlesdin C, Ansell BM, Arden GP, Swann M. Total hip replacement in children with juvenile chronic arthritis. J
Bone Joint Surg Br 1986;68(2):218-22. https://doi.org/10.1302/0301-620X.68B2.3958006
7. Clohisy JC, Oryhon JM, Seyler TM, Wells CW, Liu SS, Callaghan JJ, et al. Function and fixation of total hip
arthroplasty in patients 25 years of age or younger. Clin Orthop Relat Res 2010;468(12):3207-13. https://doi.org/10.1007/s11999-010-1468-4
8. Kutzner KP, Freitag T, Donner S, Kovacevic MP, Bieger R. Outcome of extensive varus and valgus stem
alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA. Arch Orthop Trauma Surg 2017;137(3):431-9. https://doi.org/10.1007/s00402-017-2640-z
9. Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip
arthroplasty. A comparative study. Int Orthop 2017;41(7):1347-53. https://doi.org/10.1007/s00264-016-3365-2
10. Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. A short tapered stem reduces intraoperative
complications in primary total hip arthroplasty. Clin Orthop Relat Res 2012;470(2):450-61. https://doi.org/10.1007/s11999-011-2068-7
11. Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014;96(20):1742-52. https://doi.org/10.2106/JBJS.M.00780
12. Woolson ST, Harris WH. A method of intraoperative limb length measurement in total hip arthroplasty. Clin Orthop Relat Res 1985;(194):207-10. PMID: 3978918
13. Buttaro MA, Slullitel PA, Zanotti G, Comba FM, Piccaluga F. Is a short stem suitable for patients with hip
dysplasia? A report on technical problems encountered during femoral reconstruction. Hip Int 2018;28(3):315-23.
https://doi.org/10.5301/hipint.5000562
14. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am
1954;36-A(3):451-75. PMID: 13163078
15. Tönnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dysplasia (author’s transl)]. Z Orthop Ihre Grenzgeb 1979;117(5):808-15. PMID: 549339
16. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993;14(3):231-42. https://doi.org/10.1016/8756-3282(93)90146-2
17. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
18. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
19. Loudon JR, Charnley J. Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br 1980;62-B(4):450-3. https://doi.org/10.1302/0301-620X.62B4.7430222
20. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
21. Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty.
Orthopedics 2015;38(3 Suppl):S6-13. https://doi.org/10.3928/01477447-20150215-50
22. Buttaro M, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Preservación ósea femoral con tallos cortos de fijación cervicometafisaria: Estudio radiográfico comparativo con tallos no cementados de fijación metafisaria. Rev Asoc Argent Ortop Traumatol 2014;79(4):232-6. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-74342014000400006&lng=es
23. Rainer W, Shirley MB, Trousdale RT, Shaughnessy WJ. The open triradiate cartilage: how young is too young for total hip arthroplasty? J Pediatr Orthop 2021;41(9):e793-9. https://doi.org/10.1097/BPO.0000000000001940
24. Bessette BJ, Fassier F, Tanzer M, Brooks CE. Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up. Can J Surg 2003;46(4):257-62. PMID: 12930101