Subsidence of a Single-Taper Femoral Stem in Primary Total Hip Arthroplasty: Characterization, Associated Factors, and Sequelae

Abstract

BackgroundWe characterized subsidence of an uncemented single-taper femoral stem in primary total hip arthroplasty (THA), determined factors associated with subsidence, and evaluated the impact of subsidence on outcome. MethodsThis retrospective study included 502 primary THAs performed using a single-taper stem in Dorr type-A and type-B femora between 2014 and 2018. Subsidence was measured based on distance from the greater trochanter to stem shoulder on calibrated X-rays. Demographics, case-specific data, and outcomes were collected. Changes in subsidence and variables associated with subsidence were determined. ResultsStem subsidence was 1.5 ± 2.3 mm, 1.6 ± 2.0 mm, 2.0 ± 2.6 mm, 2.3 ± 2.3 mm, 2.6 ± 2.5 mm, and 2.7 ± 3.0 mm at 6 weeks, 3 months, 6 months, 1 year, 2 years, and ≥3 years from THA, respectively. Subsidence across all patients at final mean follow-up of 24 months (range, 1 to 101 months) was 2.2 ± 2.6 mm. Pairwise comparison demonstrated that subsidence occurred predominantly within the first 6 months. Significant subsidence (≥5 mm) occurred in 17.3% and was associated with a body mass index (BMI) ≥25 (P = .04). Dorr type, age, sex, and American Society of Anesthesiologists class were not associated with subsidence. There were 2 patients (0.4%) who underwent a revision that could be attributed to subsidence. There was no association between subsidence and pain, limp, need for ambulatory aid, or analgesic use. ConclusionIn primary THAs performed using a single-taper prosthesis, average subsidence was 2.2 mm and significant subsidence occurred in 17.3%. Patient BMI was associated with subsidence. Revision surgery related to subsidence was infrequent (0.4%).