Short hip stem for THA in avascular necrosis of the femoral head

Abstract

Osteonecrosis of the femoral head or avascular necrosis of the femoral head (HKN) is acomplex disease that, without treatment, leads to infraction of the femoral head in most cases. In these cases, only replacement of the hip joint will help, although there is no clear recommendation of an arthroplasty type. In the last two decades, the treatment of primary and secondary coxarthrosis with short-shaft prostheses with different anchoring philosophies has increased. Since short-shaft fitting is apossible option especially in younger patients, the question arises about possible fittings of advanced HKN with these stem types, especially with metaphyseal anchorage. The aim of this study was to review the existing literature on the results of short stem prosthesis in HKN and to present the advantages and disadvantages of short stem prosthesis in osteonecrosis of the femoral head. This review analyzes the existing studies on short stem arthroplasty for HKN. Only a few studies exist that have analyzed clinical and radiologic outcomes of short stem replacement in HKN. The existing short- and medium-term results show mostly good outcomes. However, it is difficult to draw ageneral conclusion due to differences in stem design and fixation. Short stems with primary diaphyseal fixation do not show an increased risk of failed osseointegration or loosening. Constructions with primary metaphyseal fixation should undergo MRI to rule out the possibility of necrosis extending beyond the femoral neck.