No Clinically Important Differences in Thigh Pain or Bone Loss Between Short Stems and Conventional-length Stems in THA: A Randomized Clinical Trial

Early- to mid-term outcome of a short, cementless, titanium, flat, tapered stem for primary total hip arthroplasty: an independent series

INTRODUCTION

This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively.

METHODS

A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling.

RESULTS

In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9-98.5) and 97.0% (95% CI, 95.6-98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09-1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign.

CONCLUSIONS

The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome.

No significant differences in 60-day postoperative complication rates between conventional and shortened stems

PURPOSE

To compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study.

METHODS

The authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery.

RESULTS

Compared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109).

CONCLUSIONS

There were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS.

LEVEL OF EVIDENCE

Level IV, Retrospective comparative cohort study.

Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study

Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one.

Comparing postoperative outcomes of two fully hydroxyapatite-coated collarless stems in total hip arthroplasty through propensity score matching analysis with 2 years follow-up

A fully hydroxyapatite (HA)-coated stem such as Corail stem, that compacts the cancellous bone around the stem in total hip arthroplasty (THA), is reported to have good long-term results for more than 20 years. Although various fully HA-coated stems have being used recently, it is unclear whether there are differences in the postoperative outcomes. In this study, 224 patients (234 hips) with THA using either the Corail collarless stem or the Hydra stem were enrolled. And then we performed a retrospective comparison of the data at 2 years postoperatively using propensity score matching analysis. The postoperative modified Harris hip scores in 84 hips each group were 93.6 ± 8.2 points in the Corail group and 92.8 ± 10.1 points in the Hydra group, and there was no significant difference between the two groups. However, there was significantly less stem subsidence and rate of 3rd degree or greater stress shielding in the Corail group. Although these two stems were similar collarless fully HA-coated stems and clinical outcomes were favorable results in both groups at 2 years postoperatively, radiographic evaluations showed statistically significant differences between the two groups.

Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis

BACKGROUND

The purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems.

METHODS

We conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results.

RESULTS

Among the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02-0.09; Z = -2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76-1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59-1.40; Z = -0.44, P = 0.663).

CONCLUSIONS

We did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42021231240.

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

Background

Although the high offset Tri-Lock bone preservation stem (BPS) was used widely, few studies explored the clinical and radiological results. The purpose of this study was to determine the clinical and radiological results of high offset Tri-Lock BPS in unilateral primary total hip arthroplasty (THA) at a minimum follow-up of 3 years.

Methods

55 patients who underwent cementless THA with high offset Tri-lock BPS from 2017 to 2018 were followed for a minimum follow-up of 3 years. Patients were assessed clinically for complications, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Hip Score (OHS). Femoral offset (FO), acetabular offset (AO), hip offset (HO), HO difference, and leg length discrepancy (LLD) were measured on the anteroposterior (AP) pelvic radiograph. Standard pelvic AP and lateral radiographs were used to evaluate for evidence of bone ingrowth, stem subsidence, stem alignment, radiolucent line around the stem, osteolysis, loosening, ectopic ossification, and femoral stress shielding.

Results

No patients reported complications during hospitalization nor the follow-up period. At a mean follow-up of 42.5 months, the mean HHS, WOMAC, and OHS scores showed a significant improvement from preoperative to the latest follow-up. No patients reported thigh pain. No revision nor sign of radiographic loosening had been detected. The high offset Tri-Lock BPS significantly improved the FO and HO postoperatively. HO difference and LLD were balanced postoperatively. No sign of stem subsidence, radiolucent line, osteolysis, loosening, ectopic ossification, nor severe stress shielding (more than grade 3–4) were observed at the latest follow-up.

Conclusion

The high offset Tri-Lock BPS demonstrated excellent clinical and radiographic outcomes at a minimum follow-up of 3 years. HO difference and LLD between legs decreased significantly and achieved balance postoperatively. Long-term follow-up is required for a definitive conclusion.