We present the result of our experience in using a short femoral stem in elderly patients (>70 years of age) compared to patients younger than 70 years.
Methods
Data were prospectively collected on 138 patients who underwent 148 primary total hip arthroplasty (THA), with a conservative short stem between November 2010 and June 2014. The cohort was divided into 2 groups: the study group (group 1) comprised 57 patients (60 THA) over 70 years of age at the time of surgery, with a mean age of 75.4 years (range 70-87 years) and a mean follow-up of 26.7 months (range 9-48 months). The control group (group 2) comprised 81patients (88 THA) less than 70 years of age with a mean age of 57.4 years (range 33-69 years) and a mean follow-up of 27.3 months (range 9-54 months).
Hip function in the 2 groups was compared preoperatively and postoperatively using the Merle D'Aubigne hip score (MD) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score.
Results
At the latest follow-up, 1 calcar fracture was reported in a 54-year-old patient in the control group, which required fixation with a screw and had a favourable outcome. No cases of clinical or radiographic loosening were reported.
Clinical results showed no statistically significant differences between the 2 groups.
Conclusions
The use of the GTS conservative short stem in patients over 70 years old has shown very good results and low complication rates, comparable to those for patients younger than 70 years.
KurtzSMowatFOngKChanNLauEHalpernMPrevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.J Bone Joint Surg Am2005;87(7):1487–1497
2.
BerryDJEpidemiology: hip and knee.Orthop Clin North Am1999;30(2):183–190
3.
FitzgeraldRHJrBrindleyGWKavanaghBFThe uncemented total hip arthroplasty.Intraoperative femoral fractures. Clin Orthop Relat Res198823561–66
4.
JastyMHenshawRMO'ConnorDOHarrisWHHigh assembly strains and femoral fractures produced during insertion of uncemented femoral components.A cadaver study. J Arthroplasty1993;8(5):479–487
5.
NoblePCAlexanderJWLindahlLJYewDTGranberryWMTullosHSThe anatomic basis of femoral component design.Clin Orthop Relat Res1988235148–165
6.
OtaniTWhitesideLAFailure of cementless fixation of the femoral component in total hip arthroplasty.Orthop Clin North Am1992;23(2):335–346
7.
StulbergSDDolanMThe short stem: a thinking man's alternative to surface replacement.Orthopedics2008;31(9):885–886
8.
Morales de CanoJJGordoCIllobreJMEarly clinical results of a new conservative hip stem.Eur J Orthop Surg Traumatol2014;24(3):359–363
9.
van OldenrijkJMollemanJKlaverMPoolmanRWHaverkampDRevision rate after short-stem total hip arthroplasty: a systematic review of 49 studies.Acta Orthop2014;85(3):250–258
KhanujaHSBanerjeeSJainDPivecRMontMAShort bone-conserving stems in cementless hip arthroplasty.J Bone Joint Surg Am2014;96(20):1742–1752
12.
OhKJMishraAYangJHRadiologic bone remodeling pattern around DCPD-coated, metaphyseal-loading cementless short stems in elderly patients.Orthopedics2014;37(7):e649–e655
13.
CastelliCCRizziLShort stems in total hip replacement: current status and future.Hip Int2014;24Suppl 10S25–S28
14.
MummeTFriedrichMJAndereyaSMüller-RathRGraviusS[Metaphyseal fitting short-stem prosthesis - preliminary results of a prospective single-surgeon series].Z Orthop Unfall2014;152(5):504–509 [Article in German].
15.
MartellJMPiersonRHIIIJacobsJJRosenbergAGMaleyMGalanteJOPrimary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement.J Bone Joint Surg Am1993;75(4):554–571
16.
EnghCABobynJDGlassmanAHPorous-coated hip replacement.The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br1987;69(1):45–55
17.
EnghCABobynJDGlassmanAHPorous-coated hip replacement.The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br1987;69(1):45–55
18.
KimYHOhSHKimJSPrimary total hip arthroplasty with a second-generation cementless total hip prosthesis in patients younger than fifty years of age.J Bone Joint Surg Am2003;85-A(1):109–114
19.
CapelloWND'AntonioJAManleyMTFeinbergJRHydroxyapatite in total hip arthroplasty.Clinical results and critical issues. Clin Orthop Relat Res1998;355:200–211
20.
KellySJRobbinsCEBierbaumBEBonoJVWardDMUse of a hydroxyapatite-coated stem in patients with Dorr Type C femoral bone.Clin Orthop Relat Res2007;465(465):112–116
21.
MedingJBGalleyMRRitterMAHigh survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone.Clin Orthop Relat Res2010;468(2):441–447
22.
PipinoFKellerATissue-sparing surgery: 25 years’ experience with femoral neck preserving hip arthroplasty.J Orthop Traumatol2006;7(1):36–41
23.
FettoJFBettingerPAustinKReexamination of hip biomechanics during unilateral stance.Am J Orthop (Belle Mead NJ)1995;24(8):605–612
24.
SantoriFSManiliMFredellaNTonciOttieri MSantoriNUltra-short stems with proximal load transfer: Clinical and radiographic results at five-year follow-up.Hip Int2006;16Suppl 331–39
25.
ChenHHMorreyBFAnKNLuoZPBone remodeling characteristics of a short-stemmed total hip replacement.J Arthroplasty2009;24(6):945–950
26.
ZehAWeiseAVasarhelyiABachAGWohlrabD[Medium-term results of the Mayo™ short-stem hip prosthesis after avascular necrosis of the femoral head].Z Orthop Unfall2011;149(2):200–205
27.
Cruz-VázquezFJDe la Rosa-AguilarMGómez-LópezCA[Evaluation of the uncemented Mayo femoral stem.The first 10 years]. Acta Ortop Mex2011;25(2):108–113
28.
GoebelDSchultzWThe Mayo cementless femoral component in active patients with osteoarthritis.Hip Int2009;19(3):206–210
29.
PatelRMSmithMCWoodwardCCStulbergSDStable fixation of short-stem femoral implants in patients 70 years and older.Clin Orthop Relat Res2012;470(2):442–449
30.
HenryJDReillyDPossRTwo- to four-year experience with cemented, press-fit, and porous coated applications of the profile total hip system.Acta Orthop Belg1993;591_suppl190–194
31.
MorscherEWWidmerKHBereiterHElkeRSchenkR[Cementless socket fixation based on the “press-fit” concept in total hip joint arthroplasty].Acta Chir Orthop Traumatol Cech2002;69(1):8–15
32.
DonnellyWJKobayashiAFreemanMARadiological and survival comparison of four methods of fixation of a proximal femoral stem.J Bone Joint Surg Br1997;79(3):351–360
33.
FreemanMAPlante-BordeneuvePEarly migration and late aseptic failure of proximal femoral prostheses.J Bone Joint Surg Br1994;76(3):432–438
34.
KrismerMBiedermannRStöcklBFischerMBauerRHaidCThe prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA.Einzel-Bild-Roentgen-Analyse-femoral component analysis. J Bone Joint Surg Br1999;81(2): 273–280
35.
BerendKRLombardiAVMalloryTHDoddsKLAdamsJBCementless double-tapered total hip arthroplasty in patients 75 years of age and older.J Arthroplasty2004;19(3):288–295
36.
KonstantoulakisCAnastopoulosGPapaeliouATsoutsanisAAsimakopoulosAUncemented total hip arthroplasty in the elderly.Int Orthop1999;23(6):334–336
37.
BrownTELarsonBShenFMoskalJTThigh pain after cementless total hip arthroplasty: evaluation and management.J Am Acad Orthop Surg2002;10(6):385–392
38.
FalezFCasellaFPanegrossiGFavettiFBarresiCPerspectives on metaphyseal conservative stems.J Orthop Traumatol2008;9(1):49–54
39.
HagelAHeinWWohlrabDExperience with the Mayo conservative hip system.Acta Chir Orthop Traumatol Cech2008;75(4):288–292
40.
GheraSPavanLThe DePuy Proxima hip: a short stem for total hip arthroplasty.Early experience and technical considerations. Hip Int2009;19(3):215–220
