Short neck-preserving femoral stem for total hip arthroplasty: medium-term results of a 68-case series

• Published in: Archives of orthopaedic and trauma surgery Vol. 142; no. 8; pp. 2093 - 2101
• Main Authors: del Río-Arteaga, Marta, Payo-Ollero, Jesús, Vallejo, Mercedes, Serrano-Toledano, David, García-Benítez, Boris, Ribera, Juan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2022; Springer Nature B.V
• Subjects: Classification; Hip Arthroplasty; Hospitals; Joint replacement surgery; Medicine; Medicine & Public Health; Orthopedics; Patients; Prostheses; Surgical techniques; Transplants & implants; Short stems; Young patients; Neck preservation; Survivorship; Total hip arthroplasty
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-021-04069-7

Introduction
Short stems seem to be a good alternative for young patients as they offer promising results, rapid recovery and preservation of metaphyseal bone stock. This is one of the few studies in the literature to report medium-term clinical-radiological results for short hip stems.
Materials and methods
This prospective study evaluated 68 short femoral stems in 63 patients treated with total hip replacement. Clinical, functional and quality-of-life outcomes were measured at 6 and 12 months, and annually thereafter until the end of follow-up. The radiological analysis included measurements of potential leg length discrepancies, stem alignment and signs compatible with stress shielding.
Results
Fifty-four males (59 hips) and nine females (9 hips) of an average age of 44.3 years (range, 25–68) were studied. The most common diagnosis was osteoarthritis (51.5%). Mean overall follow-up was 7.8 years (range, 5.8–9.8). The overall survival rate was 97.1% (95% CI 88.7–99.7%). Surgery resulted in an increase of 42.3 ± 1.1 points in the modified Harris Hip Score and 21.9 ± 0.6 points in the Oxford Hip Score (
p
 < 0.001, respectively). Moreover, the pain score as measured on a numerical rating scale (NRS) improved from 95.8 to 36.3. As regards function, an improvement was observed from 3.2 ± 0.8 points to 6.8 ± 1.14 points on the University of California at Los Angeles activity score (
p
 < 0.001, respectively). The radiological analysis showed an absence of radiolucencies or stress-shielding throughout the series. The complications rate at the end of follow-up was 5.7%.
Conclusions
The use of ultra-short cylindrical stems with complete anchorage in the femoral neck was shown to offer promising medium-term results. Such stems appear to be a good option for young patients, who are likely to require several revisions over their lifetime.