Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology

article

Kutzner, Karl Philipp¹  Donner, Stefanie¹  Loweg, Lennard¹  Rehbein, Philipp¹  Dargel, Jens¹  Drees, Philipp²  Pfeil, Joachim¹ 

[1] Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden;Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz

关键词: Short-stem;    Total hip arthroplasty;    Optimys;    Mid-term;    Subsidence;    Bone remodelling;    Stress-shielding;   

DOI  :  10.1186/s10195-019-0537-z

来源: Springer

【 摘 要 】

In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage.

【 授权许可】

Unknown