Abstract
Introduction: A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described. The primary aim of this study was to evaluate objective and subjective outcome measures in primary THA with different femoral implant styles.Methods: Stems were classified into the following five classes: cemented, conical, fit and fill, modular, and wedge. The objective outcomes of interest were the length of inpatient hospital stay (LOS), 90-day readmission rate, one-year revision rate, and two-year mortality rate. Preoperative and postoperative patient-reported outcome measures (PROMs), including hip disability and osteoarthritis outcome score (HOOS) - physical function shortform (HOOS-PS), patient-reported outcomes measurement information system physical function short form 10a (PROMIS PF-10a), and patient-reported outcomes measurement information system - short form - mental 10a (PROMIS M-10a) were recorded and compared between different classes.Results: Patients with a wedge stem had a significantly lower LOS versus every other stem group, while patients with a cemented stem had the highest LOS, approximately twofold that of the wedge stem group. Accounting for potential confounders, the conical and fit and fill groups had a significantly higher two-year mortality rate than the wedge stem group. Fit and fill stems conferred a slight risk of revision THA at one-year compared to wedge stems. There was no significant difference in the rates of failure to achieve the minimal clinically important difference (MCID) for the PROMs.Conclusion: Placement of wedge stems resulted in a significantly lower LOS compared to every other stem class and a lower mortality rate than the conical, fit and fill, and modular stems. As for the 90-day readmission, one-year revision, and the rates of failure to achieve the MCID for general or hip-specific PROMs, stem design had no meaningful effect.
Highlights
A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described
This retrospective study was performed with Institutional Review Board approval using data from an arthroplasty registry within a regional network of hospitals supplemented with implant model data from the International Prostheses Library (IPL), a database of medical device information developed and maintained by the American Joint Replacement Registry (AJRR)
Five patients were discharged to a custodial care facility, 412 patients were discharged home without services, 5882 patients were discharged to home health care, six patients were discharged to hospice care, 10 patients were discharged to a long-term care facility, 234 patients were discharged to a rehabilitation facility, three were discharged to a short-term hospital, and 1,180 were discharged to a skilled nursing facility
Summary
A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described. PROMs may vary in the domains that are assessed, for example, the PROMIS-10 physical (PROMIS PF-10a) and mental (PROMIS M-10a) global health scores aim to measure the overall physical and mental health of the patient, while a PROM such as the hip disability and osteoarthritis outcome score (HOOS) focuses on pain and function of the hip joint [7,8]. All of these aforementioned PROMs have been validated for responsiveness in measuring THA outcomes, and are used extensively in THA research [6,7]. One approach to interpreting PROM scores in the context of surgical intervention is to use the minimal clinically important difference (MCID) as a threshold for changes in PROM scores reflecting meaningful changes from preoperative to the postoperative symptom states for patients [9]
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