Abstract
BackgroundEarly femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems.MethodsIn this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA).ResultsAverage stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures.ConclusionsThe examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.
Highlights
Femoral stem subsidence following a cementless Total hip arthroplasty (THA) is correlated with aseptic loosening of the femoral component
Since early stem migration might be associated with aseptic loosening of the femoral component [9], the goal of the current study was to evaluate the 5-year subsidence of a metaphyseal-anchored short femoral stem in cementless THA, and to correlate the stem subsidence with patient demographics, implant characteristics such as stem and head size, as well as clinical outcomes
Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of ≥6 vs. lower than 6 (Difference = − 1.48 mm, R2 = 37.5; p = 0.001))
Summary
Femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems. Recent evidence suggests that young, active patients undergoing a THA might have a higher risk of implant failure and subsequent revision surgery [4]. Within this population, an effective THA should aim in preserving the metaphyseal bone, providing feasible femoral revision options and allowing easier implantation with less invasive procedures. Short cementless femoral components were developed to preserve metaphyseal bone through
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