Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial (original) (raw)
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European Journal of Orthopaedic Surgery & Traumatology, 2021
Purpose Short-stem prostheses in hip arthroplasty have emerged as an alternative to conventional stems, especially in younger patients. The purpose of this study was to compare functional and radiological results of a short metaphyseal fitting cementless stem versus a conventional stem implant, in patients younger than 60 years. Methods All patients operated from January 2006 to April 2013 were included, obtaining a minimum follow-up of 7 years. Harris Hip Score (HHS) and SF-36 (quality of life) questionnaires were applied and the presence of "thigh pain" was specifically assessed. We also compared complication rate, revision rate and average prosthesis survival. Femoral stress shielding (Gruen scale), stem subsidence, varus-valgus tilt and implant stability (Engh scale) were also compared. Results A total of 101 short-stem and 74 conventional arthroplasties were included, with an average follow-up of 9.82 (7-14) years. HHS functional score and SF-36 were excellent in both implants and no significant difference between them (p > 0.05) was found. However, "thigh pain" was present in 7 patients with conventional stems and none with short-stems (p < 0.001). The survival rate at 13 years was 99%, for both implants, and no significant differences were found between them (χ 2 (2) = 0.178; p = 0.673). Conventional stems had stress shielding at the greater trochanter in 72% of the cases and 43% at the calcar, being statistically superior (p < 0.001) to the stress shielding observed in the short stems. Conclusion According to our results, this short-stem seems to allow preservation of bone stock, with decreased stress shielding and also a lower incidence of thigh pain compared to conventional stems. Level of Evidence Level III retrospective comparative study.
Cureus, 2022
Background: The objective of our study was to compare a novel squared section, tapered design-with four conicity-short stem, the MINIMA® short stem with the cementless Profemur® TL standard femoral stem in primary total hip arthroplasty (THA) in terms of functional outcomes, radiologic evaluation and other perioperative and post-operative data. Material and methods: This is a comparative study including 46 patients undergoing primary THA. In 23 patients, the MINIMA® short stem was used. These patients were matched with another 23 patients in whom a cementless Profemur® TL standard femoral stem was used. The levels of the pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS). The functional and clinical evaluation of the patients was performed with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9), and neuropathic pain questionnaire (DN-4). The rest of the comparison data included demographic data, the American Society of Anesthesiologists score (ASA), Charlson Index score, the pre-operative diagnosis, radiographic evaluation, the days of hospitalization, the operating time, incision length, blood loss, and blood transfusion requirements and complication rates. Results: The two cohorts had comparable results regarding all patients' peri-operative data. The radiographic assessment revealed considerable higher levels of femoral offset and femoral subsidence for the MINIMA group, but within acceptable limits for both cohorts. The majority of the functional and other scores did not give strong prominence to one specific femoral stem. Conclusion: Our comparative study underlined the efficacy of the MINIMA® short stem, due to the fact that it revealed comparable and, in some cases, relatively better short-term outcomes compared with the TL standard femoral stem. Yet, more well-designed long-term research is required in order to further establish its effectiveness.
PROSPECTIVE CLINICAL TRIAL ASSESSING A SHORT FEMORAL STEM PROSTHESIS IN TOTAL HIP ARTHROPLASTY
BACKGROUND AND PURPOSE: We undertook a prospective clinical trial assessing the Nanos® short stem cementless femoral prosthesis. The primary objective was to assess the implant for subsidence and rotational stability via Radiostereometric Analysis (RSA). The secondary objective was to assess functional outcome. PATIENTS AND METHODS: 28 patients undergoing unilateral Total Hip Arthroplasty (THA) using a short stem prosthesis were compared to a control group using a standard Corail® stem. Both stems were uncemented and the procedures performed by the same surgeons. Data collection points were preoperative, 3 months and 2 years post operatively. RSA radiographs were performed to assess subsidence and rotational stability. Functional analysis was undertaken using the Oxford Hip Score (OHS). RESULTS: The short stem showed a median subsidence of 0.12mm at 3 months with a further 0.09mm in the 3-24 month interval. Median posterior translation of prosthesis head (retroversion) was 0.21mm at 3 months, with a further 0.07mm in the 3-24 month interval. Varus/valgus displacements measured were minimal. The mean OHS improved from 23 preoperatively to 44 at 3 months and 43 at 24 months review. There were 2 early revisions: one for leg length discrepancy and one for early loosening secondary to under-sizing of the implant. There were no significant differences to the control group. INTERPRETATION: THA patients with this stem demonstrated good stability and excellent short-term functional results, however the high revision rate in our series remains a concern.
SICOT-J, 2022
Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. Material and Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. Results: No...
Orthopaedics & Traumatology: Surgery & Research, 2013
Background: Short femoral stems designed to spare bone stock and improve load transfer at the proximal femur level have been introduced in recent years. However, little is known on the long-term outcomes of these stems. Hypothesis: Short cementless stems have low rate of thigh pain and subsidence as well as few revision needs at mid-term follow-up. Materials and methods: We prospectively followed 64 patients (72 hips) undergoing total hip arthroplasty with a femoral stem designed to achieve a pure metaphyseal fixation. Patients with hip fracture, femoral neck deformity and osteoporotic bone were excluded. Clinical evaluations were performed annually until the last follow-up, a minimum of 9 years after surgery. At each follow-up, implant positioning was assessed on conventional plain films with a computer assisted radiographic evaluation. Results: The Harris hip score improved from 43 points (range 19-50) before surgery to 88 points (range 73-100) at the final follow-up (P = 0.001), and the Womac score averaged 47 points (range 35-56 points) preoperatively and 76 points (range 63-84) at the last follow-up (P = 0.001). Thigh pain was reported by five patients (8%) at the 2-year follow-up, but only in two (3%) was still present, and related to the prosthesis, at last follow-up. Computer assisted radiographic analysis showed a neutral alignment of the stem in 56% of cases, a varus-valgus alignment less than 5 • in 36% and equal to 5 • in 8%. Stem subsidence was observed in 12 hips but was less than 4 mm in all cases (range 0-3 mm). Calcar height remained unchanged over time. Adaptive bone remodelling, including proximal bone resorption and distal cortical hypertrophy were not observed at follow-up. No patients had aseptic loosening of the stem nor were radiolucent lines detectable at the level of the porous coating. Survivorship analysis showed a 100% survival rate of the stem at nine years.
Total hip arthroplasty utilizing an uncemented, flat, tapered stem with a reduced distal profile
Arthroplasty Today, 2019
Background: The aim of this study was to report the midterm results of an uncemented, flat, and tapered femoral stem with a reduced distal profile. Methods: 219 total hip arthroplasties were performed using this stem between March 2007 and October 2012. Survival, radiographs, and modified Harris Hip Scores were analyzed. Results: Twenty-two (11.1%) patients died from comorbidities but retained their hips; 18 (9.1%) patients were lost to follow-up. Of the remaining 179 hips, all stems remained in situ at a median follow-up of 8.4 (7.0-9.3) years. There was 97.5% (95% CI: 95.1-99.9) survival for all-cause revision with 4 hips revised for instability. Early stem subsidence was identified in 2 patients within 3 months postoperative measured at 4 mm in patient 1 and 3 mm in patient 2. Long-term radiographic follow-up showed 2 hips with incomplete radiolucencies but no evidence of stress shielding, osteolysis, or subsidence among examined hips (n ¼ 93). Spot welding and cortical hypertrophy were present in 58 (62.4%) and 50 (53.8%) hips, respectively. Femoral component position did not change from early postoperative imaging relative to long-term follow-up at 5 years (P ¼ .097). Median modified Harris Hip Scores improved from 58.3 (49.5-64.9) points preoperative to 95.7 (88.0-100) points at follow-up (P < .0001). Conclusions: The reduced distal profile stem studied showed no stem revisions at long-term follow-up with an all-cause survivorship of 97.5% at a median follow-up of 8.4 (7.0-9.3) years. The stem showed good bone integration and stability at midterm follow-up in most patients reviewed.
Primary stability of a short bone-conserving femoral stem
The Bone & Joint Journal, 2018
Aims The aim of this study was to determine the stability of a new short femoral stem compared with a conventional femoral stem in patients undergoing cementless total hip arthroplasty (THA), in a prospective randomized controlled trial using radiostereometric analysis (RSA). Patients and Methods A total of 53 patients were randomized to receive cementless THA with either a short femoral stem (MiniHip, 26 patients, mean age: 52 years, nine male) or a conventional length femoral stem (MetaFix, 23 patients, mean age: 53 years, 11 male). All patients received the same cementless acetabular component. Two-year follow-up was available on 38 patients. Stability was assessed through migration and dynamically inducible micromotion. Radiographs for RSA were taken postoperatively and at three, six, 12, 18, and 24 months. Results At two years, there was significantly less subsidence (inferior migration) of the short femoral stem (head, 0.26 mm, 95% confidence interval (CI) 0.08 to 0.43, sd 0.3...
Journal of Arthroscopy and Joint Surgery, 2017
The purpose of this study is to evaluate and compare short term results (2 years post-operative), complications and functional outcomes (gait analysis) between short-metaphyseal hip arthroplasty and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). Our patients were enrolled in three different groups, one comparing short-metaphyseal arthroplasties group and two high functional control groups. The first control group of resurfacing arthroplasties and a second of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, antero-posterior and lateral hip radiographies and were followed as outpatients for two years. At the last follow up all the patients perform a gait and static balance analysis. Statistical analysis have not revealed a significant difference between the three comparative groups regarding their demographic data nor a significant difference at the preoperative and the postoperative scores of each group. The radiographic evaluation revealed no differences and no complications. No one presented with cup or femoral loosening and no heterotopic ossification was observed. Also the comparing data of the three groups at the final 2 years postoperative control did not reveal any significant difference regarding their clinical scores and gait analysis results. The overall outcome of all three groups was similar and all the patients satisfied. We arrive at the conclusion that high functional resurfacing and big femoral head arthroplasties, present similar gait characteristics and functional outcome to the bone and soft preserving short-metaphyseal hip arthroplasties.