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Published in: European Journal of Trauma and Emergency Surgery 3/2018

01-06-2018 | Review Article

Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience

Authors: H. Wacha, G. Domsel, E. Herrmann

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2018

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Abstract

Background

An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013.

Methods

A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen–Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint.

Results

Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies.

Conclusion

The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision.

Literature
  1. Banerjee S, Pivec R, Issa K, Harwin St F, Mont MA, Khanuja HS. Outcomes of short stems in total hip arthroplasty. Orhtopedics. 2013;36(9):700–7.View Article
  2. Bitzer EM, Grobe TG, Neusser S, Schneider A, Dörning H, Schwartz FW, editor. Barmer GEK Report 2010. Schriftenreihe zur Gesundheitanalyse, Band 3. St.Augustin: Asgard-Verlag; 2010.
  3. BQS (2009). Hüftprothesen-Erstimplantation. BQS-Leistungsbereiche mit Dokumentationspflicht. Outcome, BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH 2009: 2008-D7514-L58612-P26095.
  4. Hailer N, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop. 2010;81(1):34–41.View ArticlePubMedPubMed Central
  5. Zwartelé R, Witjes S, Doets HC, Stijnen T, Pöll RG. (2012). Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature. Arch Orthop Trauma Surg 132(4): 535–46.View Article
  6. Van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D. Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop. 2014;85.(3):250–8.View ArticlePubMedPubMed Central
  7. Pipino F. A. w. D. o. O. a. T., Policlinico of Monza (2004). CFP prosthetic stem in mini-invasive total hip arthroplasty. J Orthop Traumatol 5 (3): 165–71).View Article
  8. Pipino F, Grandizio M Molfetta M. Preservation of the fermoral neck in hip arthroplasty: results of a 13-to 17-year follow-up J Orthop Traumatol. 2000;1(1):31–9.View Article
  9. Wacha H, Domsel G, Mootz R. Collum femoris retaining hip system-3 years follow-up. Orthopädische Praxis. 2007;43(8):436–44.
  10. Wacha H, Domsel G, Gawad KA. (2009). C.F.P.-Kurzschaftprothese- 5 Jahres-Ergebnisse. 58 th Jahrestagung Nord-West-Deutscher Orthopäden-Hamburg :V 22.7.
  11. Jerosch J. (2013). Kurzschaft-endoprothesen, Wo liegen die Unterschiede? Köln, Deutscher Ärzte-Verlag.
  12. Röhrl S, Li MG, Pedersen E, Ullmark G, Nivbrant B. (2006). Migration pattern of a short femoral neck preserving stem. Clin Orthop Retated Res 488: 73–8.View Article
  13. Noureddine B, D¨orner C, Scheunemann D, Wurm M, Schulz AP. (2007). Early results of the CFP prosthesis in post-traumatic hip deformity.” j.injury.2007. 11.307.
  14. Gill I, Gill K, Jayasekera N, Miller J. Medium term results of the collum femoris preserving hydroxyapatite coated total hip replacement. Hip International. 2008;18(2):75–80.View ArticlePubMed
  15. Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int Suppl. 2010;7(S5):2–7.
  16. Nowak M, Nowak TE, Schmidt R, Forst R, Kress AM, Mueller LA. (2011). “Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimum 6-year follow-up.”. Acta Orthop Trauma Surg. 131(4): 549 – 55.
  17. Briem D, Schneider M, Bogner N, Botha N, Gebauer M, Gehrke T, Schwantes B Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop. 2011 35(5):655–60.View ArticlePubMed
  18. RIPO (2013). Annual Report 2000–2011. Emilia-Romagna (RIPO. S. Report, Institut für Ergebnisforschung in der Orthopädie: 72.
  19. Wang Y, Liu M, Li JW, Hao YJ, Li JF, Yang J, Li GH. Application of CFP short-stem prosthesis in the treatment of osteonecrosis of the femoral head. Zhonghua Yi Xue Za Zhi. 2011;91(47):3320–3.PubMed
  20. Kress A, Schmidt R, Nowak TE, Nowak M, Haeberle L, Forst R, Mueller LA. Stress-related femoral cortical and cancellous bone density loss after collum femoris preserving uncemented total hip arthroplasty: a prospective 7-year follow-up with quantitative computed tomography. Arch Orthop Trauma Surg. 2012;132(8):1111–9.View ArticlePubMed
  21. Li M, Li HY, Liao K, Wen Q, Zhong T D. Mid-term effectiveness of total hip arthroplasty with collum femoris preserving prosthesis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26(8):897–901.PubMed
  22. Ghera S, Bisicchia S. The collum femoris preserving stem: early results. Hip Int. 2013;23(1):27–32.View ArticlePubMed
  23. Hutt J, Harb Z, Gill I, Kashif F, Miller J, Dodd M. (2014). Ten year results of the collum femoris preserving total hip replacement: a prospective cohort study of seventy five patients. Int Orthop 38(5): 917 – 22.
  24. Kendoff D, Citak M, Egidy CC, O’Loughlin PF, Gehrke T. Eleven-year results of the anatomic coated CFP stem in primary total hip arthroplasty. J Arthroplast. 2013;28(6):1047–51.View Article
  25. Lazarinis S, Mattsson P, Milbrink J, Mallmin H, Hailer NP. (2013). A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthop 84(1): 32–9View Article
  26. Domsel G, Th F, Hristova Y, Gawad KA. (2011) Zementfreie Kurzschaftprothese bei alten Patienten Unfallchirurg. 114 (Supplement 2):92. (Abstracts Nr.62.08.)
  27. Mäkelä K, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, Furnes O, Pedersen AB, Overgaard S, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A. (2014). Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 13(348): f7592.View Article
  28. Pedersen A, Mehnert F, Havelin LI, Furnes O, Herberts P, Kärrholm J, Garellick G, Mäkela K, Eskelinen A, Overgaard S. Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association Osteoarthr Cartil. 2014;22(5):659–67.View ArticlePubMed
  29. Rajakulendran K, Field RE. Neck-preserving femoral stems. HSS J. 2012;8(3):295–303.View ArticlePubMedPubMed Central
  30. Rometsch E, Bos PK, Koes BW. (2012). Survival of short hip stems with a “modern”, trochanter-sparing design—a systematic literature review. Hip Int. 22(4): 344–54.View Article
  31. Van Oldenrijk J, Schafroth MU, Rijk E, Runne WC, Verheyen CC, van Egmond C, Bhandari M, Poolman RW. Learning curve analysis of the Collum Femoris Preserving total hip surgical technique. Hip Int. 2013;23(2):154–61.View ArticlePubMed
  32. Aldinger P, Sabo D, Pritsch M, Thomsen M, Mau H, Ewerbeck V, Breusch SJ Pattern of periprosthetic bone remodeling around stable uncemented tapered hip stems: a prospective 84-month follow-up study and a median 156-month cross-sectional study with DXA. Calcif Tissue Int. 2003;73(2):115–21.View ArticlePubMed
  33. Albanese C, Santori FS, Pavan L, Learmonth ID, Passariello R. Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems: 37 patients followed for 3 years. Acta Orthop. 2009;80(3):291–7.View ArticlePubMedPubMed Central
  34. Götze C, Ehrenbrink J, Ehrenbrink H. Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty. Z Orthop Unfall. 2010;148(4):398–405.View ArticlePubMed
  35. Chen H, Morrey BF, An KN, Luo ZP. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty. 2009;24(6):945–50.View ArticlePubMed
  36. Schmidt R, Gollwitzer S, Nowak TE, Nowak M, Kress A, Forst R, Müller LA. (2011). Periprosthetic femoral bone reaction after total hip arthroplasty with preservation of the collum femoris: CT-assisted osteodensitometry 1 and 3 years postoperatively. Orthopäde. 40: 591–9.View ArticlePubMed
  37. Rudman K, Aspden RM, Meakin JR. Compression or tension? The stress distribution in the proximal femur. Biomed Eng Online. 2006;20(5):12.View Article
  38. Biggi F, Franchin F, Lovato R, Pipino F. DEXA evaluation of total hip arthroplasty with neck-preserving technique: 4 year follow-up. J Orthop Traumatol. 2004;5(3):156–9.View Article
  39. Howie D, Holubowycz OT, Middleton R. Large Articulation Study Group. (2012). Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 94(12): 1095–102.
  40. Sexton S, Walter WL, Jackson MP, De Steiger R, Stanford T. Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement. J Bone Joint Surg BR. 2009;91(11):1448–53.View ArticlePubMed
Metadata
Title
Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience
Authors
H. Wacha
G. Domsel
E. Herrmann
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0895-2

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