Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Short Curved Stems and Standard-length Single Wedged Stems for Cementless Total Hip Arthroplasty

  • Chan Young Lee (Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital) ;
  • Sheng-Yu Jin (Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital) ;
  • Ji Hoon Choi (Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital) ;
  • Taek-Rim Yoon (Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital) ;
  • Kyung-Soon Park (Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital)
  • Received : 2023.03.16
  • Accepted : 2023.10.30
  • Published : 2024.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to compare the clinical and radiographic outcomes with use of short-curved stems versus standard-length single wedged stems over a minimum follow-up period of five years. Materials and Methods: A retrospective study of primary total hip arthroplasties performed using the Fitmore® stem (127 hips, 122 patients) and the M/L taper® stem (195 hips, 187 patients) between October 2012 and June 2014 was conducted. The clinical and radiographic outcomes were obtained for evaluation over a minimum follow-up period of five years. Results: In both the Fitmore® and M/L taper® groups, the mean Harris hip score improved from 52.4 and 48.9 preoperatively to 93.3 and 94.5 at the final follow-up, respectively (P=0.980). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores also improved from 73.3 and 76.8 preoperatively to 22.9 and 25.6 at the final follow-up, respectively (P=0.465). Fifteen hips (Fitmore®: 14 hips; M/L taper®: one hip, P<0.001) developed intraoperative cracks and were treated simultaneously with cerclage wiring. Radiography showed a radiolucent line in 24 hips in the Fitmore® group and 12 hips in the M/L taper® group (P=0.125). Cortical hypertrophy was detected in 29 hips (Fitmore® group: 28 hips; M/L taper® group: one hip, P<0.001). Conclusion: Similarly favorable clinical and radiographic outcomes were achieved with use of both short-curved stems and standard-length single wedged stems. However, higher cortical hypertrophy and a higher rate of femoral crack were observed with use of Fitmore® stems.

Keywords

Acknowledgement

This research was supported by the best annual research grant of the Korean Hip Society 2022.

References

  1. Burchard R, Braas S, Soost C, Graw JA, Schmitt J. Bone preserving level of osteotomy in short-stem total hip arthroplasty does not influence stress shielding dimensions - a comparing finite elements analysis. BMC Musculoskelet Disord. 2017;18:343. https://doi.org/10.1186/s12891-017-1702-2
  2. Stulberg SD, Patel RM. The short stem: promises and pitfalls. Bone Joint J. 2013;95-B(11 Suppl A):57-62. https://doi.org/10.1302/0301-620X.95B11.32936
  3. Kim YH. Ultra-short bone conserving cementless femoral stem. Hip Pelvis. 2021;33:181-9. https://doi.org/10.5371/hp.2021.33.4.181
  4. Koyano G, Jinno T, Koga D, Yamauchi Y, Muneta T, Okawa A. Comparison of bone remodeling between an anatomic short stem and a straight stem in 1-stage bilateral total hip arthroplasty. J Arthroplasty. 2017;32:594-600. https://doi.org/10.1016/j.arth.2016.07.016
  5. Maier MW, Streit MR, Innmann MM, et al. Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up. BMC Musculoskelet Disord. 2015;16:371. https://doi.org/10.1186/s12891-015-0830-9
  6. Gustke K. Short stems for total hip arthroplasty: initial experience with the Fitmore stem. J Bone Joint Surg Br. 2012;94(11 Suppl A):47-51. https://doi.org/10.1302/0301-620X.94B11.30677
  7. Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM. Cementless tapered wedge femoral stems decrease subsidence in obese patients compared to traditional fit-and-fill stems. J Arthroplasty. 2017;32:891-7. https://doi.org/10.1016/j.arth.2016.09.023
  8. Ishii S, Homma Y, Baba T, Ozaki Y, Matsumoto M, Kaneko K. Does the canal fill ratio and femoral morphology of Asian females influence early radiographic outcomes of total hip arthroplasty with an uncemented proximally coated, taperedwedge stem? J Arthroplasty. 2016;31:1524-8. https://doi.org/10.1016/j.arth.2016.01.016
  9. Kim JT, Jeong HJ, Lee SJ, Kim HJ, Yoo JJ. Does proximally coated single-wedge cementless stem work well in Dorr Type C femurs? Minimum 10-year followup. Indian J Orthop. 2019;53:94-101. https://doi.org/10.4103/ortho.IJOrtho_160_17
  10. Lim YW, Song JH, Kwon SY, Kim YS, Byun YS, Lee SW. Minimum 10-year follow-up of micro-arc oxidation coating on a cementless grit-blasted tapered-wedge stem of total hip arthroplasty: a multicentre study. Hip Int. 2022;32:501-9. https://doi.org/10.1177/1120700020977465
  11. Nebergall AK, Rolfson O, Rubash HE, Malchau H, Troelsen A, Greene ME. Stable fixation of a cementless, proximally coated, double wedged, double tapered femoral stem in total hip arthroplasty: a 5-year radiostereometric analysis. J Arthroplasty. 2016;31:1267-74. https://doi.org/10.1016/j.arth.2015.11.036
  12. Carlson SW, Goetz DD, Liu SS, Greiner JJ, Callaghan JJ. Minimum 10-year follow-up of cementless total hip arthroplasty using a contemporary triple-tapered titanium stem. J Arthroplasty. 2016;31:2231-6. https://doi.org/10.1016/j.arth.2016.04.037 Erratum in: J Arthroplasty. 2017;32:1408. https://doi.org/10.1016/j.arth.2016.11.032
  13. Cho KJ, Park KS, Jang WY, Park CG, Yoon TR. Midterm results of fourth-generation ceramic-on-ceramic total hip arthroplasty. Indian J Orthop. 2019;53:630-6. https://doi.org/10.4103/ortho.IJOrtho_192_18
  14. Park KS, Yoon TR, Hwang SY, Lee KB. Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head. Indian J Orthop. 2012;46:29-35. https://doi.org/10.4103/0019-5413.91632
  15. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55. https://doi.org/10.2106/00004623-196951040-00012
  16. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45:453-61. https://doi.org/10.1002/1529-0131(200110)45:5<453::aid-art365>3.0.co;2-w
  17. Zmolek JC, Dorr LD. Revision total hip arthroplasty. The use of solid allograft. J Arthroplasty. 1993;8:361-70. https://doi.org/10.1016/s0883-5403(06)80034-3
  18. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;(141):17-27.
  19. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629-32. https://doi.org/10.2106/00004623-197355080-00006
  20. Thalmann C, Kempter P, Stoffel K, Ziswiler T, Frigg A. Prospective 5-year study with 96 short curved FitmoreTM hip stems shows a high incidence of cortical hypertrophy with no clinical relevance. J Orthop Surg Res. 2019;14:156. https://doi.org/10.1186/s13018-019-1174-1
  21. Cho YJ, Chun YS, Rhyu KH, Baek JH, Liang H. Distal femoral cortical hypertrophy after hip arthroplasty using a cementless doubletapered femoral stem. J Orthop Surg (Hong Kong). 2016;24:317-22. https://doi.org/10.1177/1602400309
  22. Crawford DA, Adams JB, Morris MJ, Berend KR, Lombardi AV Jr. Distal femoral cortical hypertrophy not associated with thigh pain using a short stem femoral implant. Hip Int. 2021;31:722-8. https://doi.org/10.1177/1120700020913872
  23. Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Niikura T, Kuroda R. Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem. Int Orthop. 2020;44:2553-8. https://doi.org/10.1007/s00264-020-04762-z
  24. Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-year followup of a short stem THA construct: excellent fixation, thigh pain a concern. Clin Orthop Relat Res. 2017;475:375-83. https://doi.org/10.1007/s11999-016-4974-1