Abstract
Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by the use of a short-stem design. Seventy consecutive patients of a randomized clinical trial were included. Of these, 67 patients met the inclusion criteria after 12 months. Thirty-five patients received a standard straight stem and 32 patients a short-stem femoral component. All surgeries were performed by a modified direct lateral approach. Isometric muscle strength of the hip abductors was evaluated preoperatively 3 and 12 months after surgery. Harris hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. After three months, there were no differences between the two groups; the abductor force was comparable to the preoperative initial values. After 12 months, a significant increase in muscle strength for the short stem patient group compared to preoperative baseline values was measured (straight-stem THA, 0.09 Nm/kg ± 0.4, p = 0.32; short-stem THA, 0.2 Nm/kg ± 0.3, p = 0.004). Comparison of the 12-month postoperative total HHS and WOMAC revealed no significant differences between both groups. A significant increase in hip abductor muscle strength 12 months after short-stem THA compared to conventional-stem THA was observed.
Highlights
During the preparation of the femoral canal in total hip arthroplasty (THA), the abductors of the hip joint sustain a certain degree of tissue alteration
There was a significant improvement in Harris hip score (HHS) (CLS: p < 0.05, Fitmore: p < 0.05) and WOMAC scores (CLS: p < 0.05, Fitmore: p < 0.05) in both groups at the three-month follow-up with no further significant changes up to 12 months (Figure 4a,b)
There were no significant differences between the two groups in terms of the HHS and the WOMAC
Summary
During the preparation of the femoral canal in total hip arthroplasty (THA), the abductors of the hip joint sustain a certain degree of tissue alteration. This may result in muscular damage, potentially leading to abductor weakness and gluteal pain [1,2]. Short-stem hip prostheses designs minimize soft tissue injury and provide a bone-preserving implantation technique [3,4]. Curved stem designs allow a calcar-guided implantation without compromising the greater trochanter region. Most straight stems affect the trochanteric bone stock, potentially leading to significant muscular damage during the implantation process [5]. With regard to the best individual outcome, full recovery of muscular strength is mandatory for postoperative function and patient satisfaction after total hip arthroplasty
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