Abstract
BackgroundThere has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA).MethodsNinety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated.ResultsAt the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes.ConclusionsComparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
Highlights
total hip arthroplasty (THA) is a highly successful procedure with regard to restoration of function and pain relief in the treatment of symptomatic hip osteoarthritis [1]
Various studies have reported on the subsidence of cementless hip stems, with some suggesting an inferior performance of short stem designs compared to conventional stems [9,10,11,12,13,14,15,16,17,18,19,20,21,22]
This could be detrimental for implant survivorship, as several authors suggested a correlation of early stem subsidence with aseptic loosening [23,24,25,26]
Summary
THA is a highly successful procedure with regard to restoration of function and pain relief in the treatment of symptomatic hip osteoarthritis [1]. Various studies have reported on the subsidence of cementless hip stems, with some suggesting an inferior performance of short stem designs compared to conventional stems [9,10,11,12,13,14,15,16,17,18,19,20,21,22] This could be detrimental for implant survivorship, as several authors suggested a correlation of early stem subsidence with aseptic loosening [23,24,25,26]. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, designed for the direct anterior approach (DAA)
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