Short Femoral Stems for Primary Total Hip Arthroplasty in Young Patients: Clinical and Biomechanical Outcomes*
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Published:
Apr 24, 2023
Keywords:
Total hip arthroplasty, short stem, hip osteoarthrosis
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Abstract
Total hip arthroplasty is an effective surgery to treat osteoarthritis. Given the rising demand for a higher quality of life, this procedure is being performed on increasingly younger patients. However, a longer life expectancy is also tied to a higher demand for multiple revision surgeries for the same patient. This poses technical challenges due to bone loss. There is a growing need to identify durable and highly functional implants that are suitable for future revision. Although cemented femoral stems were the main option in the past, uncemented femoral stems have demonstrated long-term fixation and excellent results. However, some issues related to fixation can still be improved. Short femoral stems have been developed to address some of these challenges while maintaining the good results obtained with conventional stems. This study analyzes the experience after 10 years of using short femoral stems in hip surgeries on young patients. Biomechanical outcomes and femoral bone preservation are compared, postoperative outcomes regarding return to sports are reported, and complications related to their use are evaluated. Short stems have multiple advantages when used in primary hip surgery. The indication for this type of implant is justified in young and active patients, to reproduce the results of conventional implants with less bone consumption and the possibility of future revision.
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Lucero, C. M., Slullitel, P. A., Díaz-Dilernia, F., Zanotti, G., Comba, F., & Buttaro, M. (2023). Short Femoral Stems for Primary Total Hip Arthroplasty in Young Patients: Clinical and Biomechanical Outcomes*. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 224-251. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1725
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3. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87(7):1487-97. https://doi.org/10.2106/JBJS.D.02441
4. Rajaee SS, Campbell JC, Mirocha J, Paiement GD. Increasing burden of total hip arthroplasty revisions in patients between 45 and 64 years of age. J Bone Joint Surg Am 2018;100(6):449-58. https://doi.org/10.2106/JBJS.17.00470
5. Grübl A. Cementless total hip arthroplasty with the rectangular titanium Zweymüller stem. A concise follow-up, at a minimum of fifteen years, of a previous report. J Bone Joint Surg Am 2006;88(10):2210-5.
https://doi.org/10.2106/jbjs.e.00810
6. McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up. J Bone Joint Surg Br 1997;79(6):900-7. https://doi.org/10.1302/0301-620x.79b6.7482
7. Eingartner C. Current trends in total hip arthroplasty. Ortop Traumatol Rehabil 2007;9(1):8-14. PMID: 17514169
8. Issa K, Pivec R, Wuestemann T, Tatevossian T, Nevelos J, Mont MA. Radiographic fit and fill analysis of a new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplasty 2014;29(1):192-8. https://doi.org/10.1016/j.arth.2013.04.029
9. Reimeringer M, Nuño N, Desmarais-Trépanier C, Lavigne M, Vendittoli PA. The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis. Comp Methods Biomech Biomed Engin 2013;16(11):1221-31. https://doi.org/10.1080/10255842.2012.662677
10. McTighe T, Keggi J, Stulberg D, Keppler L, Brazil D, McPherson E. Total Hip Stem Classification System. Reconstr Rev 2014;4(2):24-8. https://doi.org/10.15438/rr.v4i2.70
11. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement? Bone Joint J 2014;96-B(4):442-8. https://doi.org/10.1302/0301-620X.96B4.33036
12. Dimitriou D, Tsai T-Y, Kwon Y-M. The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty. Int Orthop 2015;39(12):2315-21. https://doi.org/10.1007/s00264-015-27391
13. Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg 2014;96(29):1742-52. https://doi.org/10.2106/jbjs.m.00780
14. Stulberg SD, Dolan M. The short stem: A thinking man’s alternative to surface replacement. Orthopedics 2008;31(9):885-6. https://doi.org/10.3928/01477447-20080901-37
15. Renkawitz T, Santori FS, Grifka J, Valverde C, Morlock MM, Learmonth ID. A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial. BMC Musculoskelet Disord 2008;9:147. https://doi.org/10.1186/1471-2474-9-147
16. Chen H-H, Morrey BF, An K-N, Luo Z-P. Bone remodeling characteristics of a short-stemmed total hip
replacement. J Arthroplasty 2009;24(6):945-50. https://doi.org/10.1016/j.arth.2008.07.014
17. Arabmotlagh M, Rittmeister M, Hennigs T. Alendronate prevents femoral periprosthetic bone loss following total hip arthroplasty: prospective randomized double-blind study. J Orthop Res 2006;24(7):1336-41. https://doi.org/10.1002/jor.20162
18. Slullitel PA, Mahatma MM, Farzi M, Grammatopoulos G, Wilkinson JM, Beaulé PE. Influence of femoral component design on proximal femoral bone mass after total hip replacement: A randomized controlled trial. J Bone Joint Surg Am 2021;103(1):74-83. https://doi.org/10.2106/JBJS.20.00351
19. Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 2011;93(5):500-9. https://doi.org/10.2106/JBJS.J.00774
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