A neck-preserving short stem better reconstructs the centre of rotation than straight stems: a computed tomography-based cadaver study

Learning curve comparison between switching approach and switching implant in cementless short stem total hip arthroplasty

INTRODUCTION

Implementing new approaches or new implants is always related with a certain learning curve in total hip arthroplasty (THA). Currently, many surgeons are switching to minimally invasive approaches combined with short stems for performing THA. Therefore, we aimed to asses and compare the learning curve of switching from an anterolateral Watson Jones approach (ALA) to a direct anterior approach (DAA) with the learning curve of switching from a neck-resecting to a partially neck-sparing short stem in cementless THA.

MATERIALS AND METHODS

The first 150 consecutive THA performed through a DAA (Group A) and the first 150 consecutive THA using a partially neck-sparing short stem (Group B) performed by a single surgeon were evaluated within this retrospective cohort study. All cases were screened for surgery related adverse events (AE). Furthermore, the operative time of each surgery was evaluated and the learning curve assessed performing a cumulative sum (CUSUM) analysis.

RESULTS

Overall, significantly more AE occurred in Group A compared to Group B (18.0% vs. 10.0%; p = 0.046). The sub-analysis of the AE revealed higher rates of periprosthetic joint infections (2.7% vs. 0.7%; p = 0.176), periprosthetic fractures (4.0% vs. 2.0%; p = 0.310) and overall revisions (4.7% vs. 1.3% p = 0.091) within Group A without statistical significance. The CUSUM analysis revealed a consistent reduction of operative time after 97 cases in Group A and 79 cases in Group B.

CONCLUSION

A significantly higher overall rate of AE was detected while switching approach compared to switching implant for performing THA. However, according to the results of this study, surgeons should be aware of the learning curve of the adoption to a new implant with different fixation philosophy as well.

Cemented Calcar-Guided Short-Stem Prostheses in Geriatric Patients: Short-Term Results from a Prospective Observational Study

Both cementless and cemented stems have exhibited favorable long-term outcomes in total hip arthroplasty. Nonetheless, in elderly patients, cemented hips offer an advantage due to their reduced risk of periprosthetic fractures. This study aimed to assess the initial outcomes of 28 patients who underwent unilateral cemented total hip arthroplasty utilizing a calcar-guided A2 stem (ARTIQO GmbH, Lüdinghausen, Germany). Various types of antibiotic-loaded bone cement were employed. During follow-up, we recorded demographic data and comorbidities and employed standardized clinical assessment tools, including the Harris Hip Score. Radiographic assessments included preoperative, postoperative, and follow-up imaging to evaluate subsidence, osteolysis, and bone resorption. The results indicated that among the 28 patients, 5 withdrew consent and 2 patients passed away from unrelated causes. Additionally, one prosthesis was explanted due to the undersizing of the cement stopper, which resulted in an inadequate cement mantle. As a result, 20 patients underwent a 1-year follow-up, revealing noteworthy enhancements in clinical scores, with no instances of radiolucent lines or osteolysis. No infections were detected. In summary, our short-term experience with this particular cemented short-stem design yielded promising results, exhibiting excellent functional outcomes, no aseptic loosening attributable to the stem, and no infections. Further clinical studies and registry data are essential to corroborate these findings.

Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis

PURPOSE

Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant.

METHODS

We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed.

RESULTS

Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm).

CONCLUSION

The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.

Hip joint function and reconstruction of the anterior femoral offset in patients with short stem vs. conventional THA

In cases where mobility and joint function are impaired after implantation of a THA, weakening of hip movement in both extension/flexion and adduction/abduction may play a role due to shortening of the physiological lever arm of the hip muscles. Mechanical factors of influence include the lateral femoral offset, which affects the lever arm, and the antetorsion angle of the hip prosthesis, which affects the anterior femoral offset. This study aimed to investigate the effect of an altered antetorsion angle of the implant on the hip moments and gait patterns of the patient. For this study, 13 patients with a conventional stem on one side and a calcar-guided short stem implanted on the contralateral side were included. To determine the maximum hip moment, tests were performed on a dynamometer in extension/flexion and adduction/abduction in addition to gait analysis. As a control, a comparison was made with data from a reference group of 30 healthy subjects. Both implants showed similar symmetry indices. There was a significant difference between the implants for adduction moments (p < 0.001). The ratios between the directions of moments showed no significant differences. The joint function measured by isokinetic measurements and gait analysis remains comparable to the healthy control group after short stem arthroplasty, but shows slight changes after conventional stem arthroplasty.

Femoral antetorsion after calcar-guided short-stem total hip arthroplasty: A cadaver study

Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles. However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcar-guided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre- and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8°  ± 7.5° vs. 23.8° ± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0° ± 5.5° in short-stem and 13.5° ± 7.1° in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre- and post-operatively (1.8° ± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3° ± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.