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Castagnini F, Pardo F, Lucchini S, Rotini M, Cavalieri B, Dalla Rosa M, Vitacca S, Di Martino A, Faldini C, Traina F. Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review. J Clin Med 2024; 13:604. [PMID: 38276110 PMCID: PMC10816713 DOI: 10.3390/jcm13020604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Marco Rotini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Bruno Cavalieri
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Mattia Dalla Rosa
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Vitacca
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Alberto Di Martino
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Cesare Faldini
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
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Mauch M, Brecht H, Clauss M, Stoffel K. Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1822. [PMID: 37893539 PMCID: PMC10608113 DOI: 10.3390/medicina59101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2-78.4) and BMI of 26.7 kg/m2 (24.6-29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre-post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen's d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen's d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6-93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.
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Affiliation(s)
- Marlene Mauch
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Hendrik Brecht
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
| | - Martin Clauss
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
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Downsizing in total hip arthroplasty. A short stem as a revision implant. DER ORTHOPADE 2021; 51:230-238. [PMID: 34581833 PMCID: PMC8894309 DOI: 10.1007/s00132-021-04168-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.
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