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Wacha H, Domsel G, Herrmann E. Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience. Eur J Trauma Emerg Surg 2018; 44:457-469. [PMID: 29344706 DOI: 10.1007/s00068-017-0895-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013. METHODS A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen-Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint. RESULTS Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies. CONCLUSION The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision.
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Affiliation(s)
- H Wacha
- Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany.
| | - G Domsel
- Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt/M, Frankfurt am Main, Germany
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Yan SG, Weber P, Steinbrück A, Hua X, Jansson V, Schmidutz F. Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2017; 42:2077-2086. [DOI: 10.1007/s00264-017-3691-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/09/2017] [Indexed: 01/26/2023]
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van Oldenrijk J, Scholtes VAB, van Beers LWAH, Geerdink CH, Niers BBAM, Runne W, Bhandari M, Poolman RW. Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip. BMJ Open 2017; 7:e014522. [PMID: 29042371 PMCID: PMC5652481 DOI: 10.1136/bmjopen-2016-014522] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Primary aim was to compare the functional results at 3 months and 2 years between short and conventional cementless stem total hip arthroplasty (THA). Secondary aim was to determine the feasibility of a double-blind implant-related trial. DESIGN A prospective blinded randomised controlled multicentre trial in patients with osteoarthritis of the hip. All patients, research assistants, clinical assessors, investigators and data analysts were blinded to the type of prosthesis. POPULATION 150 patients between 18 and 70 years with osteoarthritis of the hip, 75 in the short stem and 75 in the conventional stem group. Mean age: 60 years (SD 7). INTERVENTIONS the Collum Femoris Preserving short stem versus the Zweymuller Alloclassic conventional stem. MAIN OUTCOME MEASURES The Dutch version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes measures: Harris Hip Score, the Physical Component Scale of the SF12, the Timed Up and Go test, Pain and the EQ-5D. Feasibility outcomes: continued blinding, protocol adherence and follow-up success rate. RESULTS No significant difference between the two groups. Mean HOOS total score in the short stem group increased 32.7 points from 36.6 (95% CI 32.9 to 40.2) preoperatively to 69.3 (95% CI 66.4 to 72.1) at 3 months follow-up. Mean HOOS total score in the conventional straight stem group increased 36.3 points from 37.1 (95% CI 33.9 to 40.3) preoperatively to 73.4 (95% CI 70.3 to 76.4) at 3 months follow-up. 91.2% of patients remained blinded at 2 years follow-up. Both protocol adherence and follow-up success rate were 98%. CONCLUSIONS Functional result at 3 months and 2 years after short stem THA is not superior to conventional cementless THA. There were more perioperative and postoperative complications in the short stem group. Direct comparison of two hip implants in a double-blinded randomised controlled trial is feasible. TRIAL REGISTRATION NUMBER NTR1560.
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Affiliation(s)
- Jakob van Oldenrijk
- Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Carel H Geerdink
- Department of Orthopaedic surgery, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Bob B A M Niers
- Department of Orthopaedic surgery, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Wouter Runne
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Mohit Bhandari
- Department of Surgery, Mcmaster University, Hamilton, Ontario, Canada
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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van Beers LWAH, van Oldenrijk J, Scholtes VAB, Geerdink CH, Niers BBAM, Runne W, Bhandari M, Poolman RW. Curved versus Straight Stem Uncemented Total Hip Arthroplasty Osteoarthritis Multicenter trial (CUSTOM): design of a prospective blinded randomised controlled multicentre trial. BMJ Open 2016; 6:e010472. [PMID: 27009147 PMCID: PMC4809092 DOI: 10.1136/bmjopen-2015-010472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Answering the demands of an increasingly young and active patient population, recent developments in total hip arthroplasty (THA) have shifted towards minimising tissue damage. The Collum Femoris Preserving (CFP) stem was developed to preserve the trochanteric region of the femur, which potentially preserves the insertion of the gluteus musculature. This might accelerate early postoperative rehabilitation and improve functional outcome. Currently the functional results of the CFP stem have not been compared with conventional straight stems in a randomised controlled trial (RCT). The primary purpose of this trial is to compare the functional result of CFP stem THA with conventional uncemented straight stem THA, measured by the Dutch Hip disability and Osteoarthritis Outcome Score (HOOS) at 3-month follow-up. METHODS A prospective blinded multicentre RCT will be performed. We aim to recruit 150 patients. The patients will be randomly allocated to a THA with a straight or a curved stem. All patients, research assistants, clinical assessors and investigators will be blinded for the type of prosthesis for 5 years. Clinical assessments and roentgenograms will be taken preoperative, at 6 weeks after surgery, at 1, 2, 3, 4 and 5 years after surgery. Patient reported outcome measures (PROMs) will be obtained at the same follow-up moments. In addition, the PROMs will also be sent to the patients at 3 and 6 months after surgery. The HOOS at 3-month follow-up will be our primary outcome. ETHICS AND DISSEMINATION This trial will be performed in accordance with the Declaration of Helsinki. A local ethics committee has approved this trial. Written informed consent will be obtained from all participating patients. All serious adverse events will be reported to the ethics committee. RESULTS Results will be submitted for publication to an orthopaedics related journal. TRIAL REGISTRATION NUMBER NTR1560.
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Affiliation(s)
- Loes W A H van Beers
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopaedic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Carel H Geerdink
- Department of Orthopaedic Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - Bob B A M Niers
- Department of Orthopaedic Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - Wouter Runne
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Mohit Bhandari
- Department of Surgery, McMaster University Hospital, Hamilton, Ontario, Canada
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D. Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop 2014; 85:250-8. [PMID: 24694271 PMCID: PMC4062791 DOI: 10.3109/17453674.2014.908343] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. MATERIALS AND METHODS We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as "collum", "partial collum", or "trochanter-sparing". RESULTS AND INTERPRETATION We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on "partial collum" and "trochanter-sparing" stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from "collum stem" studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.
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Affiliation(s)
- Jakob van Oldenrijk
- Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center
| | - Jeroen Molleman
- Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center
| | - Michel Klaver
- Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center
| | - Rudolf W Poolman
- Department of Orthopedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Slotervaartziekenhuis, Amsterdam, the Netherlands.
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Lazarinis S, Mattsson P, Milbrink J, Mallmin H, Hailer NP. A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthop 2013; 84:32-9. [PMID: 23343375 PMCID: PMC3584599 DOI: 10.3109/17453674.2013.765623] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Short femoral stems have been introduced in total hip arthroplasty in order to save proximal bone stock. We hypothesized that a short stem preserves periprosthetic bone mineral density (BMD) and provides good primary stability. METHODS We carried out a prospective cohort study of 30 patients receiving the collum femoris-preserving (CFP) stem. Preoperative total hip BMD and postoperative periprosthetic BMD in Gruen zones 1-7 were investigated by dual-energy x-ray absorptiometry (DXA), stem migration was analyzed by radiostereometric analysis (RSA), and the Harris hip score (HHS) was determined. RESULTS 2 patients were excluded intraoperatively and 1 patient was revised due to a deep infection, leaving 27 patients for analysis. The mean HHS increased from 49 (24-79) preoperatively to 99 (92-100) after 2 years. DXA after 1 year showed substantial loss of BMD in Gruen zone 7 (-31%), zone 6 (-19%), and zone 2 (-13%, p < 0.001) compared to baseline BMD determined immediately postoperatively. The bone loss in these regions did not recover after 2 years, whereas the more moderate bone loss in Gruen zones 1, 3, and 5 partially recovered. There was a correlation between low preoperative total hip BMD and a higher amount of bone loss in Gruen zones 2, 6 and 7. RSA showed minor micromotion of the stem: mean subsidence was 0.13 (95% CI: -0.28 to 0.01) mm and mean rotation around the longitudinal axis was 0.01º (95% CI: -0.1 to 0.39) after 2 years. INTERPRETATION We conclude that substantial loss in proximal periprosthetic BMD cannot be prevented by the use of a novel type of short, curved stem, and forces appear to be transmitted distally. However, the stems showed very small migration-a characteristic of stable uncemented implants.
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Affiliation(s)
- Stergios Lazarinis
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
| | - Per Mattsson
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
| | - Jan Milbrink
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
| | - Hans Mallmin
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
| | - Nils P Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
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Valverde-Mordt C, Valverde-Belda D. Prótesis femorales conservadoras. Vástagos cortos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recot.2011.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Conservative femoral implants. Short stems. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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