Abstract
BackgroundDue to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young (< 60 years) and a geriatric (> 75 years) population.MethodsData were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision.ResultsNo differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively.ConclusionsAdvanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B.Trial registrationGerman Clinical Trials Register; DRKS00012634, 07.07.2017 (retrospectively registered).
Highlights
Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients
We identified 14 hips lost-to-follow-up in the young group and 11 in the elderly group
Four elderly patients were known to be deceased before the minimum follow-up of 12 months and 6 patients, 3 from each group, underwent stem revision for various reasons before the time point of 12 months of follow-up
Summary
Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. Total hip arthroplasty (THA) has been deemed as “the operation of the century” due to its excellent clinical outcome and patient satisfaction rates [1]. This highly effective procedure was originally intended for elderly, low-demand patients but improvements in implant technology, tribology, and surgical techniques led to the extension of indications over a wide range of ages. Due to its bone preserving philosophy, short-stem THA has initially been recommended for young and active patients with adequate bone quality [8]. Because of increased activity levels and longer life expectancy, these patients have a higher probability for revision during their life-span, and bone preservation during the index procedure is crucial [9]
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