Abstract
AimThe length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics.MethodsPatients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare.ResultsWith the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem.ConclusionBy testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.
Highlights
Bone and soft tissue preservation during arthroplasty continue to be at the forefront of twenty-first century research [1]
Short stems are at risk of insertional malalignment and have been found to have a lower primary load at failure when compared to a conventional stem [2, 10, 11]
A retrospective gait study attempted to shed light on this subject, conclusions were limited by its cohort design, which was open to selection bias [12]
Summary
Bone and soft tissue preservation during arthroplasty continue to be at the forefront of twenty-first century research [1]. An increasing number of younger patients require surgery who frequently have narrower diaphyseal canals, which make conventional longer stems more of a surgical challenge In this challenging group, a shorter stem may provide an easier and potentially bone conserving alternative. Gait analysis of subjects with both a short and long-stemmed THA on opposing sides provide a better control for patient associated variables, allowing a more objective measure of any functional differences conferred by the use of stems of different length. This type of study design has been successfully used before to demonstrate substantial functional differences between resurfacing and conventional total hip replacement implants
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