Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience
- 270 Downloads
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.
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.
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.
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.
KeywordsShort stem arthroplasty Retrospective Single center study
HW and GD collected all information and reports from the patients, HW prepared the database for statistical analysis, EH performed the statistical analysis and all authors were involved in writing the manuscript.
Compliance with ethical standards
Conflict of interest
This study was partially financed by FA Link, Hamburg, Germany. The authors did not receive benefits for personal use.
This study was approved by the local Ethical board Review Committee: FF66/2015.
This retrospective study does not afford additional informed consent bedsides the preoperative consent of the patients.
- 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.Google Scholar
- 3.BQS (2009). Hüftprothesen-Erstimplantation. BQS-Leistungsbereiche mit Dokumentationspflicht. Outcome, BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH 2009: 2008-D7514-L58612-P26095.Google Scholar
- 9.Wacha H, Domsel G, Mootz R. Collum femoris retaining hip system-3 years follow-up. Orthopädische Praxis. 2007;43(8):436–44.Google Scholar
- 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.Google Scholar
- 11.Jerosch J. (2013). Kurzschaft-endoprothesen, Wo liegen die Unterschiede? Köln, Deutscher Ärzte-Verlag.Google Scholar
- 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.Google Scholar
- 15.Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int Suppl. 2010;7(S5):2–7.Google Scholar
- 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.Google Scholar
- 18.RIPO (2013). Annual Report 2000–2011. Emilia-Romagna (RIPO. S. Report, Institut für Ergebnisforschung in der Orthopädie: 72.Google Scholar
- 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.CrossRefPubMedGoogle Scholar
- 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.Google Scholar
- 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): 32–9CrossRefGoogle Scholar
- 26.Domsel G, Th F, Hristova Y, Gawad KA. (2011) Zementfreie Kurzschaftprothese bei alten Patienten Unfallchirurg. 114 (Supplement 2):92. (Abstracts Nr.62.08.)Google Scholar
- 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.CrossRefGoogle Scholar
- 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.CrossRefPubMedGoogle Scholar
- 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.CrossRefPubMedGoogle Scholar
- 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.Google Scholar