Stable fixation of an ultra-short femoral neck-preserving hip prosthesis: a 5-year RSA, DXA, and clinical prospective outcome study of 48 patients
DOI:
https://doi.org/10.2340/17453674.2024.40074Keywords:
Arthroplasty, Bone, DXA, Hip, Implants, Migration, RSAAbstract
Background and purpose: We previously showed promising primary stability and preservation of bone stock with the ultra-short neck-loading hip implant in total hip arthroplasty (THA). The aim of this study was to evaluate clinical outcome, implant stability, and bone mineral density (BMD).
Methods: 50 patients were treated with the ultra-short neck Primoris hip implant at baseline and 48 were available for evaluation at 5-year follow-up. 5 different patient-reported outcome measures (PROMs) including hip-specific scores, disease-specific and generic quality of life outcome measures, and an activity score were used. Furthermore, implant stability using radiostereometric analysis (RSA) and assessment of periprosthetic BMD using dual-energy X-ray absorptiometry (DXA) were applied.
Results: By 1-year follow-up, all PROMs showed improvements and remained high at 5-year follow-up. After initial distal translation (subsidence) and negative rotation around the z-axis (varus tilt) the implant showed stable fixation at 5-year follow-up with no further migration beyond 12 months. In the regions of interest (ROI) 3 and 4, BMD remained stable. In ROI 2, further bone loss of 12% was found at 5-year follow-up.
Conclusion: Clinical outcome including PROMs was satisfying throughout the 5-year follow-up period. The hip implant remains stable with both bone preservation and loss 5 years after surgery.
Downloads
References
Lazarinis S, Mattsson P, Milbrink J, Mallmin H, Hailer N P. A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Acta Orthop 2013; 84(1): 32-9. doi: 10.3109/17453674.2013.765623. DOI: https://doi.org/10.3109/17453674.2013.765623
Liu Y, Wei W, Zeng Y, Ma J, Yang J, Shen B. Comparison of femoral bone mineral density changes around 3 common designs of cementless stems after total hip arthroplasty: a retrospective cohort study. Orthop Surg 2022 25; 14(6): 1059-70. doi: 10.1111/os.13265. DOI: https://doi.org/10.1111/os.13265
Nysted M, Benum P, Klaksvik J, Foss O, Aamodt A. Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem. Acta Orthop 2011; 82(4): 410-6. doi: 10.3109/17453674.2011.588860. DOI: https://doi.org/10.3109/17453674.2011.588860
Ender A S, Machner A, Pap G, Hubbe J, Graßhoff H, et al. Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years. Acta Orthop 2007; 78(5): 616-21. doi: 10.1080/17453670710014301. DOI: https://doi.org/10.1080/17453670710014301
Hayaishi Y, Miki H, Nishii T, Hananouchi T, Yoshikawa H, et al. Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type. J Arthroplasty 2007; 22(8): 1208-13. doi: 10.1016/j.arth.2006.11.001. DOI: https://doi.org/10.1016/j.arth.2006.11.001
Panisello J J, Canales V, Herrero L, Herrera A, Mateo J, Caballero M J. Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem. Int Orthop 2009; 33(2): 373-9. doi: 10.1007/s00264-007-0501-z. DOI: https://doi.org/10.1007/s00264-007-0501-z
Synder M, Krajewski K, Sibinski M, Drobniewski M. Periprosthetic Bone remodeling around short stem. Orthopedics 2015; 38(3): S40-5. doi: 10.3928/01477447-20150215-55. DOI: https://doi.org/10.3928/01477447-20150215-55
von Lewinski G, Floerkemeier T. 10-year experience with short stem total hip arthroplasty. Orthopedics 2015; 38(3 Suppl.): S51-6. doi: 10.3928/01477447-20150215-55. DOI: https://doi.org/10.3928/01477447-20150215-57
Khanuja H S, Banerjee S, Jain D, Pivec R, Mont M A. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014; 96(20): 1742-52. doi: 10.2106/JBJS.M.00780. DOI: https://doi.org/10.2106/JBJS.M.00780
Albanese C V, Santori F S, Pavan L, Learmonth I D, Passariello R. Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems. Acta Orthop 2009; 80(3): 291-7. doi: 10.3109/17453670903074467. DOI: https://doi.org/10.3109/17453670903074467
Christiansen J D, Ejaz A, Nielsen P T, Laursen M. An ultra-short femoral neck-preserving hip prosthesis. J Bone Joint Surg 2020; 102(2): 128-36. doi: 10.2106/JBJS.19.00104. DOI: https://doi.org/10.2106/JBJS.19.00104
Valstar E R, Gill R, Ryd L, Flivik G, Börlin N, Kärrholm J. Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 2005; 76(4): 563-72. doi: 10.1080/17453670510041574. DOI: https://doi.org/10.1080/17453670510041574
Christiansen J D, Laursen M B, Ejaz A, Nielsen P T. Bone remodelling of the proximal femur after total hip arthroplasty with 2 different hip implant designs: 15 years follow-up of the thrust plate prosthesis and the Bi-Metric stem. Hip Int 2018; 28(6): 606-12. doi: 10.1177/1120700018755371. DOI: https://doi.org/10.1177/1120700018755371
Elm E von, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335(7624): 806-8. doi: 10.1136/bmj.39335.541782.AD. DOI: https://doi.org/10.1136/bmj.39335.541782.AD
Hossain F, Konan S, Volpin A, Haddad F S. Early performance-based and patient-reported outcomes of a contemporary taper fit bone-conserving short stem femoral component in total hip arthroplasty. Bone Joint J 2017; 99-B(4_Supple_B): 49-55. doi: 10.1302/0301-620X.99B4.BJJ-2016-1291.R1. DOI: https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1291.R1
Freitag T, Hein M-A, Wernerus D, Reichel H, Bieger R. Bone remodelling after femoral short stem implantation in total hip arthroplasty: 1-year results from a randomized DEXA study. Arch Orthop Trauma Surg 2016; 136(1): 125-30. doi: 10.1007/s00402-015-2370-z. DOI: https://doi.org/10.1007/s00402-015-2370-z
del Río-Arteaga M, Payo-Ollero J, Vallejo M, Serrano-Toledano D, García-Benítez B, Ribera J. Short neck-preserving femoral stem for total hip arthroplasty: medium-term results of a 68-case series. Arch Orthop Trauma Surg 2022; 142(8): 2093-101. doi: 10.1007/s00402-021-04069-7. DOI: https://doi.org/10.1007/s00402-021-04069-7
Brinkmann V, Radetzki F, Delank K S, Wohlrab D, Zeh A. A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses. J Orthop Traumatol 2015; 16(3): 237-43. doi: 10.1007/s10195-015-0335-1. DOI: https://doi.org/10.1007/s10195-015-0335-1
Babu S, Singh P, Wiik A, Shastri O, Malik K, Bailey J, et al. A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis. Hip Int 2020; 30(5): 513-22. doi: 10.1177/1120700019888210. DOI: https://doi.org/10.1177/1120700019888210
Wolf O, Mattsson P, Milbrink J, Larsson S, Mallmin H. Periprosthetic bone mineral density and fixation of the uncemented CLS stem related to different weight bearing regimes: a randomized study using DXA and RSA in 38 patients followed for 5 years. Acta Orthop 2010; 81(3): 286-91. doi: 10.3109/17453674.2010.487238. DOI: https://doi.org/10.3109/17453674.2010.487238
Salemyr M, Muren O, Ahl T, Bodén H, Eisler T, Stark A, et al. Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthop 2015; 86(6): 659-66. doi: 10.3109/17453674.2015.1067087. DOI: https://doi.org/10.3109/17453674.2015.1067087
Kim Y-H, Park J-W. Long-term outcomes of ultra-short metaphyseal-fitting anatomic cementless femoral stem in total hip arthroplasty with ceramic-on-ceramic articulation for young patients. J Arthroplasty 2019; 34(10): 2427-33. doi: 10.1016/j.arth.2019.04.036. DOI: https://doi.org/10.1016/j.arth.2019.04.036
Rudman K, Aspden R, Meakin J. Compression or tension? The stress distribution in the proximal femur. Biomed Eng Online 2006; 5(1): 12. doi: 10.1186/1475-925X-5-12. DOI: https://doi.org/10.1186/1475-925X-5-12
Malchau H. On the importance of stepwise introduction of a new hip implant technology [thesis]. Göteborg, Sweden; 1995. ISBN: 91-628-1658-6.
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Janus D Christiansen, Mogens Laursen, Gordon W Blunn, Poul T Nielsen
This work is licensed under a Creative Commons Attribution 4.0 International License.
