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Open Access 01-03-2021 | Hip-TEP | Original Paper

Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation

Authors: Guido Garavaglia, Amanda Gonzalez, Christophe Barea, Robin Peter, Pierre Hoffmeyer, Anne Lübbeke, Didier Hannouche

Published in: International Orthopaedics | Issue 3/2021

Abstract

Purpose

Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation.

Methods

Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2–9.73 years).

Results

During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2–7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between − 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1.

Conclusion

Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.

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Title: Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation
Authors: Guido Garavaglia
Amanda Gonzalez
Christophe Barea
Robin Peter
Pierre Hoffmeyer
Anne Lübbeke
Didier Hannouche
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: International Orthopaedics / Issue 3/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04910-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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