Abstract
Short-stem total hip arthroplasty has been proposed as a bone-conserving procedure for the younger and more active population undergoing total hip arthroplasty. Although various short stems are currently available, no studies compare the outcomes between these stems. The aim of the current study was to conduct a systematic review of the clinical and radiographic outcomes of the various short stems that have been approved for use in the United States by the Food and Drug Administration. Outcomes that were assessed included implant survivorship, Harris Hip scores, thigh pain, periprosthetic fracture, subsidence, proximal stress shielding, and the prevalence of stem malalignment and inappropriate implant sizing.
- 1.Kolb A, Grubl A, Schneckener CD, Cementless total hip arthroplasty with the Rectangular Titanium Zweymuller Stem: a concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg Am. 2012; 94(18):1681–1684.
10.2106/JBJS.K.01574 Crossref Medline, Google Scholar - 2.McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up. J Bone Joint Surg Br. 1997; 79(6):900–907.
10.1302/0301-620X.79B6.7482 Crossref Medline, Google Scholar - 3.Bordini B, Stea S, De Clerico M, Strazzari S, Sasdelli A, Toni A. Factors affecting aseptic loosening of 4750 total hip arthroplasties: multivariate survival analysis. BMC Musculoskelet Disord. 2007; 8:69.
10.1186/1471-2474-8-69 Crossref Medline, Google Scholar - 4.Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011; 93(5):500–509.
10.2106/JBJS.J.00774 Crossref Medline, Google Scholar - 5.Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002; 10(6):385–392. Crossref Medline, Google Scholar
- 6.Engh CA, Young AM, Engh CA, Hopper RH. Clinical consequences of stress shielding after porous-coated total hip arthroplasty. Clin Orthop Relat Res. 2003; (417):157–163. Medline, Google Scholar
- 7.Bugbee WD, Culpepper WJ, Engh CA, Engh CA. Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement. J Bone Joint Surg Am. 1997; 79(7):1007–1012. Crossref Medline, Google Scholar
- 8.McElroy MJ, Johnson AJ, Mont MA, Bonutti PM. Short and standard stem prostheses are both viable options for minimally invasive total hip arthroplasty. Bull NYU Hosp Jt Dis. 2011; 69(suppl 1):S68–S76. Medline, Google Scholar
- 9.Kim YH, Kim JS, Park JW, Joo JH. Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Joint Surg Br. 2011; 93(5):587–592. Crossref Medline, Google Scholar
- 10.Lazovic D, Zigan R. Navigation of short-stem implants. Orthopedics. 2006; 29(10 suppl):S125–S129. Medline, Google Scholar
- 11.Lombardi AV, Berend KR, Adams JB. A short stem solution: through small portals. Orthopedics. 2009; 32(9).
10.3928/01477447-20090728-09 Link, Google Scholar - 12.Ghera S, Pavan L. The DePuy Proxima hip: a short stem for total hip arthroplasty. Early experience and technical considerations. Hip Int. 2009; 19(3):215–220. Crossref Medline, Google Scholar
- 13.Lerch M, Kurtz A, Stukenborg-Colsman C, Bone remodeling after total hip arthroplasty with a short stemmed metaphyseal loading implant: finite element analysis validated by a prospective dexa investigation. J Orthop Res. 2012; 30(11):1822–1829.
10.1002/jor.22120 Crossref Medline, Google Scholar - 14.Pipino F, Keller A. Tissue-sparing surgery: 25 years’ experience with femoral neck preserving hip arthroplasty. J Orthop Traumatol. 2006; 7(1):36–41.
10.1007/s10195-006-0120-2 Crossref, Google Scholar - 15.Pipino F, Calderale PM. Biodynamic total hip prosthesis. Ital J Orthop Traumatol. 1987; 13(3):289–297. Medline, Google Scholar
- 16.Engh CA, O’Connor D, Jasty M, McGovern TF, Bobyn JD, Harris WH. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res. 1992; (285):13–29. Medline, Google Scholar
- 17.Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res. 1986; (208):108–113. Medline, Google Scholar
- 18.Jasty M, Bragdon C, Burke D, O’Connor D, Lowenstein J, Harris WH. In vivo skeletal responses to porous-surfaced implants subjected to small induced motions. J Bone Joint Surg Am. 1997; 79(5):707–714. Crossref Medline, Google Scholar
- 19.Whiteside LA, White SE, McCarthy DS. Effect of neck resection on torsional stability of cementless total hip replacement. Am J Orthop (Belle Mead NJ). 1995; 24(10):766–770. Medline, Google Scholar
- 20.Carlson L, Albrektsson B, Freeman MA. Femoral neck retention in hip arthroplasty. A cadaver study of mechanical effects. Acta Orthop Scand. 1988; 59(1):6–8.
10.3109/17453678809149333 Crossref Medline, Google Scholar - 21.Tanner KE, Yettram AL, Loeffler M, Goodier WD, Freeman MA, Bonfield W. Is stem length important in uncemented endoprostheses?Med Eng Phys. 1995; 17(4):291–296.
10.1016/1350-4533(95)90854-5 Crossref Medline, Google Scholar - 22.Ender SA, Machner A, Pap G, Hubbe J, Grashoff H, Neumann HW. Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years. Acta Orthop. 2007; 78(5):616–621. Medline, Google Scholar
- 23.Ishaque BA, Donle E, Gils J, Wienbeck S, Basad E, Sturz H. Eight-year results of the femoral neck prosthesis ESKA-CUT [in German]. Z Orthop Unfall. 2009; 147(2):158–165.
10.1055/s-0029-1185527 Crossref Medline, Google Scholar - 24.Niggemeyer O, Steinhagen J, Ruether W. Long-term results of the thrust plate prosthesis in patients with rheumatoid arthritis: a minimum 10-year follow-up. J Orthop Sci. 2010; 15(6):772–780.
10.1007/s00776-010-1548-z Crossref Medline, Google Scholar - 25.Gilbert RE, Salehi-Bird S, Gallacher PD, Shaylor P. The Mayo Conservative Hip: experience from a district general hospital. Hip Int. 2009; 19(3):211–214. Crossref Medline, Google Scholar
- 26.Kim YH, Park JW, Kim JS. Is diaphyseal stem fixation necessary for primary total hip arthroplasty in patients with osteoporotic bone (class C bone)?J Arthroplasty. 2013; 28(1):139.e1–146.e1.
10.1016/j.arth.2012.04.002 Crossref, Google Scholar - 27.Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br. 2000; 82(7):952–958.
10.1302/0301-620X.82B7.10420 Crossref Medline, Google Scholar - 28.Falez F, Casella F, Panegrossi G, Favetti F, Barresi C. Perspectives on metaphyseal conservative stems. J Orthop Traumatol. 2008; 9(1):49–54.
10.1007/s10195-008-0105-4 Crossref Medline, Google Scholar - 29.Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res. 2012; 470(2):450–461.
10.1007/s11999-011-2068-7 Crossref Medline, Google Scholar - 30.Santori FS, Santori N. Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br. 2010; 92(9):1231–1237. Crossref Medline, Google Scholar
- 31.Toth K, Mecs L, Kellermann P. Early experience with the Depuy Proxima short stem in total hip arthroplasty. Acta Orthop Belg. 2010; 76(5):613–618. Medline, Google Scholar
- 32.Kim YH, Kim JS, Park JW, Joo JH. Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Joint Surg Br. 2011; 93(5):587–592. Crossref Medline, Google Scholar
- 33.Cruz-Vazquez FJ, De la Rosa-Aguilar M, Gomez-Lopez CA. Evaluation of the uncemented Mayo femoral stem. The first 10 years [in Spanish]. Acta Ortop Mex. 2011; 25(2):108–113. Medline, Google Scholar
- 34.Zeh A, Weise A, Vasarhelyi A, Bach AG, Wohlrab D. Medium-term results of the Mayo short-stem hip prosthesis after avascular necrosis of the femoral head [in German]. Z Orthop Unfall. 2011; 149(2):200–205.
10.1055/s-0030-1270710 Crossref Medline, Google Scholar - 35.Gagala J, Mazurkiewicz T. Early experiences in the use of Mayo stem in hip arthroplasty [in Polish]. Chir Narzadow Ruchu Ortop Pol. 2009; 74(3):152–156. Medline, Google Scholar
- 36.Goebel D, Schultz W. The Mayo cementless femoral component in active patients with osteoarthritis. Hip Int. 2009; 19(3):206–210. Crossref Medline, Google Scholar
- 37.Hagel A, Hein W, Wohlrab D. Experience with the Mayo conservative hip system. Acta Chir Orthop Traumatol Cech. 2008; 75(4):288–292. Medline, Google Scholar
- 38.Hube R, Zaage M, Hein W, Reichel H. Early functional results with the Mayo-hip, a short stem system with metaphyseal-intertrochanteric fixation [in German]. Orthopade. 2004; 33(11):1249–1258.
10.1007/s00132-004-0711-7 Crossref Medline, Google Scholar - 39.Tadeusz N, Adam N, Lukasz N. Total hip replacement in young patients with use of MAYO prosthesis—early result of treatment [in Polish]. Chir Narzadow Ruchu Ortop Pol. 2007; 72(5):319–321. Medline, Google Scholar
- 40.Kim YH, Oh JH. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. J Bone Joint Surg Br. 2012; 94(6):774–781. Crossref Medline, Google Scholar
- 41.Patel RM, Smith MC, Woodward CC, Stulberg SD. Stable fixation of short-stem femoral implants in patients 70 years and older. Clin Orthop Relat Res. 2012; 470(2):442–449.
10.1007/s11999-011-2063-z Crossref Medline, Google Scholar - 42.Stulberg SD, Dolan M. The short stem: a thinking man’s alternative to surface replacement. Orthopedics. 2008; 31(9):885–886.
10.3928/01477447-20080901-37 Link, Google Scholar - 43.Finn H. Cementless total hip arthroplasty with a short femoral component. http://www.biomet.com/orthopedics/productDetail.cfm?category=2&product=239. Accessed on November 15, 2012. Google Scholar
- 44.Emerson RJ, Jones K, Kavolus CH, Peyton RS, Pietrzak WS. Short-term clinical outcomes of the taperloc microplasty stem. http://www.biomet.com/orthopedics/productDetail.cfm?category=2&product=239. Accessed on November 15, 2012. Google Scholar
- 45.MacDonald SJ, Rosenzweig S, Guerin JS, Proximally versus fully porous-coated femoral stems: a multicenter randomized trial. Clin Orthop Relat Res. 2010; 468(2):424–432.
10.1007/s11999-009-1092-3 Crossref Medline, Google Scholar - 46.Nishino T, Mishima H, Miyakawa S, Kawamura H, Ochiai N. Midterm results of the Synergy cementless tapered stem: stress shielding and bone quality. J Orthop Sci. 2008; 13(6):498–503.
10.1007/s00776-008-1272-0 Crossref Medline, Google Scholar - 47.Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW. Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg Br. 1993; 75(2):279–287. Crossref Medline, Google Scholar
- 48.Aamodt A, Lund-Larsen J, Eine J, Andersen E, Benum P, Husby OS. Changes in proximal femoral strain after insertion of uncemented standard and customised femoral stems. An experimental study in human femora. J Bone Joint Surg Br. 2001; 83(6):921–929.
10.1302/0301-620X.83B6.9726 Crossref Medline, Google Scholar - 49.Bieger R, Ignatius A, Decking R, Claes L, Reichel H, Durselen L. Primary stability and strain distribution of cementless hip stems as a function of implant design. Clin Biomech (Bristol, Avon). 2012; 27(2):158–164.
10.1016/j.clinbiomech.2011.08.004 Crossref Medline, Google Scholar - 50.Walde HJ, Walde TA. Minimally invasive orthopedic surgery: first results in navigated total hip arthroplasty. Orthopedics. 2006; 29(10 suppl):S139–S141. Medline, Google Scholar
- 51.Vresilovic EJ, Hozack WJ, Rothman RH. Incidence of thigh pain after uncemented total hip arthroplasty as a function of femoral stem size. J Arthroplasty. 1996; 11(3):304–311.
10.1016/S0883-5403(96)80083-0 Crossref Medline, Google Scholar - 52.Pierannunzii LM. Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics. 2008; 31(7):691–699.
10.3928/01477447-20110505-05 Crossref Medline, Google Scholar - 53.Gill TJ, Sledge JB, Orler R, Ganz R. Lateral insufficiency fractures of the femur caused by osteopenia and varus angulation: a complication of total hip arthroplasty. J Arthroplasty. 1999; 14(8):982–987.
10.1016/S0883-5403(99)90014-1 Crossref Medline, Google Scholar - 54.Woolson ST, Maloney WJ. Cementless total hip arthroplasty using a porous-coated prosthesis for bone ingrowth fixation. 3 1/2-year follow-up. J Arthroplasty. 1992; (7 suppl):381–388.
10.1016/S0883-5403(07)80028-3 Crossref Medline, Google Scholar - 55.Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY. The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplasty. 2008; 23(3):418–423.
10.1016/j.arth.2007.04.002 Crossref Medline, Google Scholar - 56.Vresilovic EJ, Hozack WJ, Rothman RH. Radiographic assessment of cementless femoral components. Correlation with intraoperative mechanical stability. J Arthroplasty. 1994; 9(2):137–141.
10.1016/0883-5403(94)90062-0 Crossref Medline, Google Scholar - 57.Ries MD, Lynch F, Jenkins P, Mick C, Richman J. Varus migration of PCA stems. Orthopedics. 1996; 19(7):581–585. Medline, Google Scholar
- 58.Engh CA, Bobyn JD, Galssman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987; 69(1):45–55. Crossref Medline, Google Scholar
- 59.Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988; (231):7–28. Medline, Google Scholar

