Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation.
According to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values.
Fifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time.
The short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years.
Level of evidence
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Kim Y-H (2005) Long-term results of the cementless porous-coated anatomic total hip prosthesis. J Bone Jt Surg Br 87(5):623–627. https://doi.org/10.1302/0301-620X.87B5.15554
Lombardi AV, Berend KR, Mallory TH (2006) Hydroxyapatite-coated titanium porous plasma spray tapered stem: experience at 15–18 years. Clin Orthop Relat Res 453:81–85
Marshall AD, Mokris JG, Reitman RD et al (2004) Cementless titanium tapered-wedge femoral stem. J Arthroplasty 19(5):546–552. https://doi.org/10.1016/j.arth.2004.01.006
Mason JB (2008) The new demands by patients in the modern era of total joint arthroplasty: a point of view. Clin Orthop Relat Res 466(1):146–152. https://doi.org/10.1007/s11999-007-0009-2
Maradit Kremers H, Larson DR, Crowson CS et al (2015) Prevalence of total hip and knee replacement in the United States. J Bone Jt Surg Am 97(17):1386–1397. https://doi.org/10.2106/JBJS.N.01141
Kurtz S, Mowat F, Ong K et al (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Jt Surg Am 87(7):1487–1497. https://doi.org/10.2106/JBJS.D.02441
Eskelinen A, Remes V, Helenius I et al (2005) Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4661 primary replacements followed for 0–22 years. Acta Orthop 76(1):28–41. https://doi.org/10.1080/00016470510030292
Goebel D, Schultz W (2009) The Mayo cementless femoral component in active patients with osteoarthritis. Hip Int 19(3):206–210
Banerjee S, Pivec R, Issa K et al (2013) Outcomes of short stems in total hip arthroplasty. Orthopedics 36(9):700–707. https://doi.org/10.3928/01477447-20130821-06
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):344–354. https://doi.org/10.5301/HIP.2012.9472
Patel RM, Stulberg SD (2014) The rationale for short uncemented stems in total hip arthroplasty. Orthop Clin N Am 45(1):19–31. https://doi.org/10.1016/j.ocl.2013.08.007
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2018) Hip, knee and shoulder arthroplasty: 2018 Annual Report
Schnurr C, Loucif A, Patzer T et al (2018) Short stem survival after osteonecrosis of the femoral head. Arch Orthop Trauma Surg 138(4):573–579. https://doi.org/10.1007/s00402-018-2892-2
Budde S, Seehaus F, Schwarze M et al (2016) Analysis of migration of the Nanos® short-stem hip implant within 2 years after surgery. Int Orthop 40(8):1607–1614. https://doi.org/10.1007/s00264-015-2999-9
Kaipel M, Grabowiecki P, Sinz K et al (2015) Migration characteristics and early clinical results of the NANOS® short-stem hip arthroplasty. Wien Klin Wochenschr 127(9–10):375–378. https://doi.org/10.1007/s00508-015-0756-0
Ettinger M, Ettinger P, Lerch M et al (2011) The NANOS short stem in total hip arthroplasty: a mid term follow-up. Hip Int 21(5):583–586. https://doi.org/10.5301/HIP.2011.8658
Stadler N, Lehner J, Abbas R et al (2016) Prospective mid-term results of a consecutive series of a short stem. Acta Orthop Belg 82(2):372–375
Capone A et al (2017) Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study. BMC Musculoskelet Disord 18:301
Schmidutz F, Grote S, Pietschmann M et al (2012) Sports activity after short-stem hip arthroplasty. Am J Sports Med 40(2):425–432. https://doi.org/10.1177/0363546511424386
Malcolm TL, Szubski CR, Nowacki AS et al (2014) Activity levels and functional outcomes of young patients undergoing total hip arthroplasty. Orthopedics 37(11):e983–e992. https://doi.org/10.3928/01477447-20141023-55
Albers A, Aoude AA, Zukor DJ et al (2016) Favorable results of a short, tapered, highly porous, proximally coated cementless femoral stem at a minimum 4-year follow-up. J Arthroplasty 31(4):824–829. https://doi.org/10.1016/j.arth.2015.08.020
Brokelman RBG, Haverkamp D, van Loon C et al (2012) The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol 3(2):101–105. https://doi.org/10.1007/s12570-012-0100-3
Brokelman RBG, van Loon CJM, Rijnberg WJ (2003) Patient versus surgeon satisfaction after total hip arthroplasty. J Bone Jt Surg Br 85(4):495–498
Shin Y-S, Suh D-H, Park J-H et al (2016) Comparison of specific femoral short stems and conventional-length stems in primary cementless total hip arthroplasty. Orthopedics 39(2):e311–e317. https://doi.org/10.3928/01477447-20160222-04
Chammaï Y, Brax M (2015) Medium-term comparison of results in obese patients and non-obese hip prostheses with Metha® short stem. Eur J Orthop Surg Traumatol 25(3):503–508. https://doi.org/10.1007/s00590-014-1574-1
Floerkemeier T, Tscheuschner N, Calliess T et al (2012) Cementless short stem hip arthroplasty METHA® as an encouraging option in adults with osteonecrosis of the femoral head. Arch Orthop Trauma Surg 132(8):1125–1131. https://doi.org/10.1007/s00402-012-1524-5
Wittenberg RH, Steffen R, Windhagen H et al (2013) Five-year results of a cementless short-hip-stem prosthesis. Orthop Rev (Pavia) 5(1):e4. https://doi.org/10.4081/or.2013.e4
Thorey F, Hoefer C, Abdi-Tabari N et al (2013) Clinical results of the metha short hip stem: a perspective for younger patients? Orthop Rev (Pavia) 5(4):e34. https://doi.org/10.4081/or.2013.e34
Nowak M, Nowak TE, Schmidt R et al (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. Arch Orthop Trauma Surg 131(4):549–555. https://doi.org/10.1007/s00402-010-1189-x
Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Jt Surg Br 82(7):952–958. https://doi.org/10.1302/0301-620x.82b7.10420
Falez F, Casella F, Panegrossi G et al (2008) Perspectives on metaphyseal conservative stems. J Orthop Traumatol 9(1):49–54. https://doi.org/10.1007/s10195-008-0105-4
Gagała J, Mazurkiewicz T (2009) Wczesne doświadczenia w zastosowaniu trzpieni Mayo w protezoplastyce bioder (Early experiences in the use of Mayo stem in hip arthroplasty). Chir Narzadow Ruchu Ortop Pol 74(3):152–156
Gilbert RE, Salehi-Bird S, Gallacher PD et al (2009) The Mayo conservative hip: experience from a district general hospital. Hip Int 19(3):211–214. https://doi.org/10.1177/112070000901900304
Zeh A, Weise A, Vasarhelyi A et al (2011) Mittelfristige Ergebnisse der Mayo™-Kurzschaftprothese bei Hüftkopfnekrose (Medium-term results of the Mayo™ short-stem hip prosthesis after avascular necrosis of the femoral head). Z Orthop Unfall 149(2):200–205. https://doi.org/10.1055/s-0030-1270710
Martins LGG, Garcia FL, Picado CHF (2014) Aseptic loosening rate of the Mayo femoral stem with medium-term follow up. J Arthroplasty 29(11):2122–2126. https://doi.org/10.1016/j.arth.2014.06.023
Cruz-Vázquez FJ, La Rosa-Aguilar M, de Gómez-López CA (2011) Evaluación del vástago de cadera "Mayo" no cementado Los primeros 10 años (Evaluation of the uncemented Mayo femoral stem. The first 10 years). Acta Ortop Mex 25(2):108–113
Arnholdt J, Gilbert F, Blank M et al (2017) The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a university level 1 department. BMC Musculoskelet Disord 18(1):250. https://doi.org/10.1186/s12891-017-1613-2
Boller S, Jahnke A, Augustin L et al (2019) Age-related osseointegration of a short hip stem: a clinical and radiological 24 months follow-up. Arch Orthop Trauma Surg 139(3):405–410. https://doi.org/10.1007/s00402-018-3082-y
Nash W, Harris A (2014) The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. J Orthop Surg (Hong Kong) 22(1):92–95. https://doi.org/10.1177/230949901402200123
Gkagkalis G, Goetti P, Mai S et al (2019) Cementless short-stem total hip arthroplasty in the elderly patient—is it a safe option? A prospective multicentre observational study. BMC Geriatr 19(1):112. https://doi.org/10.1186/s12877-019-1123-1
Hube R, Zaage M, Hein W et al (2004) Frühfunktionelle Ergebnisse einer Kurzschaftprothese des Hüftgelenks mit metaphysär-intertrochantärer Verankerung (Early functional results with the Mayo-hip, a short stem system with metaphyseal-intertrochanteric fixation). Orthopade 33(11):1249–1258. https://doi.org/10.1007/s00132-004-0711-7
McLaughlin JR, Lee KR (1997) Total hip arthroplasty with an uncemented femoral component. Excellent results at 10-year follow-up. J Bone Jt Surg Br 79(6):900–907. https://doi.org/10.1302/0301-620x.79b6.7482
Reimeringer M, Nuño N, Desmarais-Trépanier C et al (2013) The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis. Comput Methods Biomech Biomed Eng 16(11):1221–1231. https://doi.org/10.1080/10255842.2012.662677
Demey G, Fary C, Lustig S et al (2011) Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study. J Arthroplasty 26(8):1549–1555. https://doi.org/10.1016/j.arth.2011.03.030
One of the authors received payment for instructional courses for Arthrex and Richard Wolf.
Conflict of interest
Dr. Zimmerer, Ms. Slouka, Dr. Fritz, Dr. Kinkel and Prof. Weiss report no conflict of interest. Dr. Miehlke reports personal fees from Arthrex, personal fees from Richard Wolf, outside the submitted work. Dr. Sobau reported no conflict of interest.
This study was approved by IRB/Ethikkommission Landesärztekammer Baden-Württemberg, Germany.
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Zimmerer, A., Slouka, S., Kinkel, S. et al. Comparison of short-stem with conventional-stem prostheses in total hip arthroplasty: an 8-year follow-up study. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03519-y
- Total hip replacement
- Short stem
- Hip pain
- Hip prosthesis
- Young patient