Abstract
BackgroundThe use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation. However, cemented short-stem designs may increase the risk of varus stem malalignment and influence patient outcomes.Methods/DesignCASINO is a multi-centre randomised equivalence trial that will recruit 220 patients undergoing total hip arthroplasty for osteoarthritis at two NHS hospitals in Scotland. Patients will be aged 45–80, undergoing unilateral primary hip arthroplasty, with no plan for contralateral procedure within the study timeframe, and able to comply with the protocol. Participants will be randomised to receive either a short (125 mm) or a standard (150 mm) Exeter V40 stem. The Contemporary acetabular component will be used in all cases. All implants will be cemented.Patient pain, function and satisfaction will be assessed using change from baseline measurement in Oxford Hip Score, Forgotten Joint Score, EQ-5D, pain numerical rating scores, and patient satisfaction questionnaire at baseline and at 1 and 2 years following surgery. Radiographic assessment will evaluate stem position and will be appraised by independent reviewers. Patients will be blind to implant allocation.DiscussionStem length may be associated with outcome; however, we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty. The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems.Trial registrationInternational Standard Randomised Controlled Trial Number, ISRCTN13154542, Registered on 30 June 2017.
Highlights
The use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation
Stem length may be associated with outcome; we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty
The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems
Summary
The primary aim of CASINO is to evaluate whether differences in the length of femoral stem used results in differences in patient outcomes following total hip arthroplasty. The Exeter V40 is the dominant brand of cemented femoral stem used in the UK with greater than 60% of market share [20]. The stem range has been expanded to include short stem options. Whilst national joint registries collect data regarding the implantable devices, the granularity of implant data is variable and few routinely collate patient outcome scores. There is no randomized trial evidence to evaluate whether the outcome of 125 mm short stem procedures are equivalent to those following procedures carried with the original 150 mm stem length
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