Background: The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs.

Methods: We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild- Röntgen-Analysis Femoral Component Analysis software.

Results: The mean follow-up was 33.8±14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at six years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0±8.9. The mean axial migration at last follow-up was 1.90±1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index.

Conclusion: The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.

Introduction:The design and length of femoral stems are undergoing enormous progress over the years.The literature has been rich when it comes to short and standard stems,unlike the shortened stems,in particular the cemented ones,which appeared later and are currently the subject of much debate.The objective of this series was to study the clinical and radiological results of cemented shortened stems.

Methods:This was a retrospective descriptive study extended from 2018 to 2021 about patients who had had a total hip arthroplasty (THA) with a shortened cemented stem.We collected patient demographic data,indications for THA,preoperative and postoperative clinical data (VAS and gait, PMA score (Postel-Merle-d'Aubigné), Harris hip score (HHS)(for non-traumatic THA)), postoperative radiographic data (quality of cementation, assessment of stem collapse, leg length discrepancy (LLD)..),intra-operative and postoperative complications and patient satisfaction.The results were evaluated 6 months postoperatively and at the last follow-up.

Results:We collected 42 patients.The average age was 60 years old.The indications for THA were:31 non-traumatic causes and 11 femoral neck fractures.The anterior approach was performed in 90%.The mean follow-up was 36 months.A significant improvement in all clinical scores was noted.The quality of cementation was classified as grade A in 62% and B in 38% at the last follow-up,the average collapse of the stems was 0mm at 6 months and 2mm at the last follow-up,the average LLD was 4mm at 6 months and 5mm at the last follow-up.We did not note any intra-operative or postoperative complications.The patients were satisfied and very satisfied at 6 months and at the last follow-up.

Discussion:Our series constitutes,to our knowledge,one of the first series studying functional and radiological outcome of cemented shortened stems.The short-term results (36 months) are satisfactory.These stems offer,on the one hand,the advantages of cementation:primary stability,avoiding possible complications of impacted stems:collapse,stress shielding,thigh pain,and on the other hand,the advantages of shortened stems:ease of placement via the anterior approach and greater metaphyseal fill with good axial alignment.

Conclusion:Cemented shortened stems could be an interesting alternative in patients who are candidates for THA.They combine the advantages of other stem models and avoid their drawbacks.This is to be attested in larger series with a longer follow-up.

Background:

A well-fixed short stem is challenging in case of revision surgery due to the curved design, the triple taper and the calcar-guided "round the corner" implantation technique. Conventional straight extraction chisel systems are limited and bear a high risk of perforation. Often a transfemoral approach is needed, causing severe damage to the patient. 

Method:

A curved extraction chisel system has been developed for the optimys-stem, involving a chuck to the cone and taking into account the particular stem design, in order to allow a safe and bone-conserving extraction in case of revision.

Surgical Technique:

Choice of a standard approach to the hip joint. Luxation. Removal of the implanted head. Preparation of the proximal femur and removal of bone at the stem shoulder. Attachment of the chuck to the cone. Insertion of the Prestarter chisels through the guided slots of the chuck, starting with the lateral chisel, followed by the ventral and dorsal chisel. The cut must point outwards away from the implant. Repetition of this procedure using the Starter chisels in the same order. Removal of the chuck. Careful insertion of the Final chisels in the same order. Trial of a stem extraction using an extraction-tool. Optional repetition of the whole procedure. In order to avoid fractures, opening of the medial interface only after preparation laterally, ventrally and dorsally, by careful insertion of the medial chisels in the respective order alongside the calcar. Finally, extraction of the stem.

Results:

The described procedure has proven successful in clinical practice in the three author affiliations in a total of 14 cases. In 3 (21.4%) cases, despite the use of the extraction chisel system, an additional transfemoral approach or fenestration had to be performed to remove the short stem.  Primary straight stems were used in over half of the cases (57.8%) as revision implants, whereas in 4 cases (36.4%) again a cementless short stem could be used.

The concept of femoral neck preserving prosthesis was introduced in 90s especially for young active patient. The goal is to sustain a good viable bone stock to facilitate eventual revision. We prospectivaly enrolled 50 patients with mean age of 52 years and with follow up of a mean 75 months. Clinical results using Harris Hip Score (HHS) were excellent to good in 95% . Radiological assesement revealed survival of the prosthesis in 96%. The results confirm excellent clinical function and survival of the CFP.

Abstract

There are few reported results for more than 8 years of a custom made proximal-loading anatomic cementless femoral stem with partial TI and HA coating. The purpose of this study was to evaluate the long-term (minimum 8 years) clinical results, bone remodeling, revision rate, and survivorship of these implants in patients aged more than 50 years.

Methods

We are in the initial phase of our study and we included 7 patients (9 hips), including 3 men and 4 women. The mean age of patients at index surgery was 57.71 years (range, 51-67 years). Mean follow-up was 8.57 years (range, 8-10 years).

Results

The Harris Hip Score at the final follow-up was a mean 94.57 points (range, 93-96 points). No femoral component neither acetabulum were revised. Survivorship of the implants at 8.57 years (mean follow-up) was 100% for the acetabular component and for the femoral component.

Conclusion

Custom made proximal-loading anatomic cementless stem functioned very well, with no osteolysis, subsidence or stress shielding at an aerage 8.57 years follow-up.