Short femoral stems with metaphyseal or meta-diaphyseal fitting in total hip arthroplasty: a systematic review
Keywords:
Total Hip Arthroplasty; Short Femoral Stems; Metaphyseal Fitting
Abstract
Background: Great variety of short stem designs have been introduced in the market in order to find the ideal combination of bone and soft tissue preservation, optimal stress distribution, excellent functional outcome and survival rates.
Purpose: Summarize and analyze the published data, in terms of clinical and radiological outcomes, complications, revision rates, and implant survival, on tapered-wedge short femoral stems which have metaphyseal only or metaphyseal-proximally diaphyseal fixation and require conventional neck osteotomy.
Methods: Review of literature databases, using the MEDLINE, Embase, and Web of Science, was conducted based on strict inclusion and exclusion criteria to identify studies reporting clinical and radiological outcomes for this specific type of short femoral stems.
Results: Thirty-six studies involving 3535 patients (3786 hips) with a mean age of 61.3 (27.5-74.42) years in a mean follow up of 45.54 (12-120) months were included. Mean Harris Hip Score improved from 45.72 (27.29-60) to 91.44 (83.1–100). The mean University of California at Los Angeles activity level and mean Merle d’Aubigné functional score was improved from 3.71 (3-3.9) to 6.06 (4.7-7.5) and 10.4 (8.5–11.5) to 17.29 (15.5–17.8) points, respectively. Femoral stem was implanted in neutral coronal alignment in 63.6% hips. A total of 30 studies reported revision rate, which was 0.03% (0-17%) and 12 studies presented component survivorship, which was 99% (96-100%) in average of 5.5 years.
Conclusions: Short, tapered-wedge stems with metaphyseal or meta-diaphyseal fitting demonstrate similar excellent clinical outcomes, survivorship and revision rates with low incidence of complications, as the conventional length or other types of short femoral components. Some concerns regarding the incidence of stress shielding phenomenon and coronal stem malalignment have been raised, requiring further evaluation through long-term studies.
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References
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2. Chen W-L, Zhang L, Huang Y-J, Cai C-Y, Lin R-X, Jing G. [Clinical apprehension on application of Tri-lock BPS total hip arthroplasty]. Zhongguo Gu Shang. 2014 Apr 23;27:58–61.
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10. Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am. 2014 Oct;96(20):1742–52.
11. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement? Bone Jt J. 2014;96 B(4):442–8.
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18. de Waard S, Sierevelt IN, Jonker R, Hoornenborg D, van der Vis HM, Kerkhoffs GMMJ, et al. The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA. HIP Int. 2021;31(4):507–15.
19. Graceffa, A; Indelli, P. F.; Latella, L; Poli, P; Fulco, A; Marcucci M. Clinical outcome of design modifications to the CLS Spotorno Stem in total hip replacement. 2016;4(2):6–11.
20. Uemura K, Hamada H, Ando W, Takao M, Sugano N. Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating. Mod Rheumatol. 2021;31(5):1066–72.
21. Peng L, Ma J, Zeng Y, Wu Y, Si H, Shen B. Clinical and radiological results of high offset tri lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow up of 3 years. J Orthop Surg Res. 2021;1–9.
22. Saragaglia D, Orfeuvre B. Mid-term results of 119 Taperloc MicroplastyTM femoral stems after a mean 61 months (50–82) of follow-up. Orthop Traumatol Surg Res. 2020;106(8):1501–6.
23. Thalmann C, Kempter P, Stoffel K, Ziswiler T, Frigg A. Prospective 5-year study with 96 short curved FitmoreTM hip stems shows a high incidence of cortical hypertrophy with no clinical relevance. J Orthop Surg Res. 2019;14(1):1–9.
24. Lidder S, Epstein DJ, Scott G. A systematic review of short metaphyseal loading cementless stems in hip arthroplasty. Bone Jt J. 2019;101 B(5):502–11.
25. National Joint Registry. 18th Annual Report Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020. 2020;(December 2020).
26. Report A, Registry S. Swiss National Hip & Knee Joint Registry - Report 2020. Annual Report of the SIRIS Registry, Hip & Knee, 2012-2019. 2020;1–114.
27. Guo J, Tan J, Peng L, Song Q, Kong H ran, Wang P, et al. Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty. Orthop Surg. 2021;13(3):749–57.
28. Hayashi S, Hashimoto S, Kanzaki N, Kuroda R, Kurosaka M. Daily activity and initial bone mineral density are associated with periprosthetic bone mineral density after total hip arthroplasty. HIP Int. 2016;26(2):169–74.
29. Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Nishida K, Ishida K, et al. Stem anteversion mismatch to the anatomical anteversion causes loss of periprosthetic bone density after THA. J Orthop Surg. 2017;25(3):1–6.
30. Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Niikura T, Kuroda R. Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem. Int Orthop. 2020;44(12):2553–8.
31. Pierannunzii LMC. Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics. 2008 Jul;31(7):691.
32. Jo W-L, Lee Y-K, Ha Y-C, Park M-S, Lyu S-H, Koo K-H. Frequency, Developing Time, Intensity, Duration, and Functional Score of Thigh Pain After Cementless Total Hip Arthroplasty. J Arthroplasty. 2016 Jun 1;31(6):1279–82.
33. Pogliacomi F, Schiavi P, Grappiolo G, Ceccarelli F, Vaienti E. Outcome of short versus conventional stem for total hip arthroplasty in the femur with a high cortical index: a five year follow-up prospective multicentre comparative study. Int Orthop. 2020;44(1):61–8.
34. Schilcher J, Ivarsson I, Perlbach R, Palm L. No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty. 2017;32(4):1220–6.
35. Malahias M-A, Tejaswi P, Chytas D, Kadu V, Karanikas D, Thorey F. The clinical outcome of the Metha short hip stem: a systematic scoping review. HIP Int. 2020 Feb 4;31(1):24–33.
36. Yan SG, Li D, Yin S, Hua X, Tang J, Schmidutz F. Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty: A systematic review and meta-analysis of randomized-controlled trials. Med (United States). 2017;96(47).
37. Tatani, I; Solou, K; Panagopoulos, A; Lakoumentas, J; Kouzelis, A; Megas P, Tatani I, Solou K, Panagopoulos A, Lakoumentas J, Kouzelis A, et al. Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial. J Orthop Surg Res. 2021 May;16(1):316.
38. Albers A, Aoude A, Zukor D, Huk O, Antoniou J, Tanzer M. Favorable Results of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem at a Minimum 4-Year Follow-Up. J Arthroplasty. 2015 Aug 1;31.
39. Ulivi M, Meroni V, Orlandini L, Lombardo M. Clinical Performance, Patient Reported Outcome and Radiological Results of a Short, Tapered, Porous, Proximally-Coated Cementless Femoral Stem: Results up to Seven Years Follow Up. J Arthroplasty. 2017 Dec 1;33.
40. Sivaloganathan S, Maillot C, Harman C, Villet L, Rivière C. Neck-sparing short femoral stems: A meta-analysis. Orthop Traumatol Surg Res. 2020;106(8):1481–94.
41. Drosos, George.I; Tottas, Stylianos; Kougioumtzis, Ioannis; Tikeridis, Konstantinos; Chatzipapas, Christos; Ververidis A. Total hip replacement using MINIMA® short stem: A short-term follow-up study. World J Orthop. 2020;5836(4).
42. Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern. Clin Orthop Relat Res. 2017;475(2):375–83.
43. Kutzner KP, Donner S, Loweg L, Rehbein P, Dargel J, Drees P, et al. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol. 2019;20(1).
44. Kobayashi A, Donnelly WJ, Scott G, Freeman MAR. Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Jt Surg - Ser B. 1997;79(4):583–9.
45. Karrholm J, Borssen B, Lowenhielm G, Snorrason F. Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br. 1994 Nov 1;76-B(6):912–7.
46. Hochreiter J, Mattiassich G, Ortmaier R, Steinmair M, Anderl C. Femoral bone remodeling after short-stem total hip arthroplasty: a prospective densitometric study. Int Orthop. 2020;44(4):753–9.
47. Slullitel P, Mahatma M, Farzi M, Grammatopoulos G, Wilkinson J, Beaulé P. Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial. J Bone Jt Surg. 2020 Oct 20;Publish Ah.
48. Maier MW, Streit MR, Innmann MM, Krüger M, Nadorf J, Kretzer JP, et al. Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up Orthopedics and biomechanics. BMC Musculoskelet Disord. 2015;16(1):1–9.
49. Sariali E, Catonne Y, Pascal-Moussellard H. Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop. 2017;41(4):699–705.
50. Tostain O, Debuyzer E, Benad K, Putman S, Pierache A, Girard J, et al. Ten-year outcomes of cementless anatomical femoral implants after 3D computed tomography planning. Follow-up note. Orth
2. Chen W-L, Zhang L, Huang Y-J, Cai C-Y, Lin R-X, Jing G. [Clinical apprehension on application of Tri-lock BPS total hip arthroplasty]. Zhongguo Gu Shang. 2014 Apr 23;27:58–61.
3. Zhen P, Chang Y, Yue H, Chen H, Zhou S, Liu J, et al. Primary total hip arthroplasty using a short bone-conserving stem in young adult osteoporotic patients with Dorr type C femoral bone. J Orthop Surg Res. 2021;16(1):1–10.
4. Migliorini F, Driessen A, Colarossi G, El Mansy Y, Gatz M, Tingart M, et al. Short stems for total hip replacement among middle-aged patients. Int Orthop. 2020 May;44(5):847–55.
5. Zhang Z, Xing Q, Li J, Jiang Z, Pan Y, Hu Y, et al. A comparison of short-stem prostheses and conventional stem prostheses in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med. 2021;9(3):231–231.
6. Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study. J Arthroplasty. 2018;33(6):1794–9.
7. Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow ARJ, Pearson RG. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J. 2017;99B(4):17–25.
8. Guo J, Tan J, Peng L, Song Q, Kong H ran, Wang P, et al. Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty. Orthop Surg. 2021;(January):1–9.
9. Tatani I, Megas P, Panagopoulos A, Diamantakos I, Nanopoulos P, Pantelakis S. Comparative analysis of the biomechanical behavior of two different design metaphyseal-fitting short stems using digital image correlation. Biomed Eng Online. 2020;19(1):1–18.
10. Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am. 2014 Oct;96(20):1742–52.
11. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement? Bone Jt J. 2014;96 B(4):442–8.
12. McTighe, Dr. HS (hc) T, Keggi, MD J, Stulberg, MD D, Keppler, MD L, Brazil, PhD D, McPherson, MD E. Total Hip Stem Classification System. Reconstr Rev. 2014;4(2):24–8.
13. Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics. 2015;38(3):S6–13.
14. Gómez-García F, Fernández-Fairen M, Espinosa-Mendoza RL. A proposal for the study of cementless short-stem hip prostheses. Acta Ortop Mex. 2016;30(4):204–15.
15. Tournier M, Goulet P, Fonvieille N, Nerini D, Johnson M. French Hip & Knee Society classification of short-stem hip prostheses: inter- and intra-observer reproducibility. J Mar Syst. 2020;103608.
16. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Med. 2009 Jul 21;6(7):e1000097.
17. OCEBM Levels of Evidence Working Group*. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. [Internet]. Available from: http://www.cebm.net/index.aspx?o=5653
18. de Waard S, Sierevelt IN, Jonker R, Hoornenborg D, van der Vis HM, Kerkhoffs GMMJ, et al. The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA. HIP Int. 2021;31(4):507–15.
19. Graceffa, A; Indelli, P. F.; Latella, L; Poli, P; Fulco, A; Marcucci M. Clinical outcome of design modifications to the CLS Spotorno Stem in total hip replacement. 2016;4(2):6–11.
20. Uemura K, Hamada H, Ando W, Takao M, Sugano N. Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating. Mod Rheumatol. 2021;31(5):1066–72.
21. Peng L, Ma J, Zeng Y, Wu Y, Si H, Shen B. Clinical and radiological results of high offset tri lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow up of 3 years. J Orthop Surg Res. 2021;1–9.
22. Saragaglia D, Orfeuvre B. Mid-term results of 119 Taperloc MicroplastyTM femoral stems after a mean 61 months (50–82) of follow-up. Orthop Traumatol Surg Res. 2020;106(8):1501–6.
23. Thalmann C, Kempter P, Stoffel K, Ziswiler T, Frigg A. Prospective 5-year study with 96 short curved FitmoreTM hip stems shows a high incidence of cortical hypertrophy with no clinical relevance. J Orthop Surg Res. 2019;14(1):1–9.
24. Lidder S, Epstein DJ, Scott G. A systematic review of short metaphyseal loading cementless stems in hip arthroplasty. Bone Jt J. 2019;101 B(5):502–11.
25. National Joint Registry. 18th Annual Report Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020. 2020;(December 2020).
26. Report A, Registry S. Swiss National Hip & Knee Joint Registry - Report 2020. Annual Report of the SIRIS Registry, Hip & Knee, 2012-2019. 2020;1–114.
27. Guo J, Tan J, Peng L, Song Q, Kong H ran, Wang P, et al. Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty. Orthop Surg. 2021;13(3):749–57.
28. Hayashi S, Hashimoto S, Kanzaki N, Kuroda R, Kurosaka M. Daily activity and initial bone mineral density are associated with periprosthetic bone mineral density after total hip arthroplasty. HIP Int. 2016;26(2):169–74.
29. Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Nishida K, Ishida K, et al. Stem anteversion mismatch to the anatomical anteversion causes loss of periprosthetic bone density after THA. J Orthop Surg. 2017;25(3):1–6.
30. Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Niikura T, Kuroda R. Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem. Int Orthop. 2020;44(12):2553–8.
31. Pierannunzii LMC. Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics. 2008 Jul;31(7):691.
32. Jo W-L, Lee Y-K, Ha Y-C, Park M-S, Lyu S-H, Koo K-H. Frequency, Developing Time, Intensity, Duration, and Functional Score of Thigh Pain After Cementless Total Hip Arthroplasty. J Arthroplasty. 2016 Jun 1;31(6):1279–82.
33. Pogliacomi F, Schiavi P, Grappiolo G, Ceccarelli F, Vaienti E. Outcome of short versus conventional stem for total hip arthroplasty in the femur with a high cortical index: a five year follow-up prospective multicentre comparative study. Int Orthop. 2020;44(1):61–8.
34. Schilcher J, Ivarsson I, Perlbach R, Palm L. No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty. 2017;32(4):1220–6.
35. Malahias M-A, Tejaswi P, Chytas D, Kadu V, Karanikas D, Thorey F. The clinical outcome of the Metha short hip stem: a systematic scoping review. HIP Int. 2020 Feb 4;31(1):24–33.
36. Yan SG, Li D, Yin S, Hua X, Tang J, Schmidutz F. Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty: A systematic review and meta-analysis of randomized-controlled trials. Med (United States). 2017;96(47).
37. Tatani, I; Solou, K; Panagopoulos, A; Lakoumentas, J; Kouzelis, A; Megas P, Tatani I, Solou K, Panagopoulos A, Lakoumentas J, Kouzelis A, et al. Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial. J Orthop Surg Res. 2021 May;16(1):316.
38. Albers A, Aoude A, Zukor D, Huk O, Antoniou J, Tanzer M. Favorable Results of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem at a Minimum 4-Year Follow-Up. J Arthroplasty. 2015 Aug 1;31.
39. Ulivi M, Meroni V, Orlandini L, Lombardo M. Clinical Performance, Patient Reported Outcome and Radiological Results of a Short, Tapered, Porous, Proximally-Coated Cementless Femoral Stem: Results up to Seven Years Follow Up. J Arthroplasty. 2017 Dec 1;33.
40. Sivaloganathan S, Maillot C, Harman C, Villet L, Rivière C. Neck-sparing short femoral stems: A meta-analysis. Orthop Traumatol Surg Res. 2020;106(8):1481–94.
41. Drosos, George.I; Tottas, Stylianos; Kougioumtzis, Ioannis; Tikeridis, Konstantinos; Chatzipapas, Christos; Ververidis A. Total hip replacement using MINIMA® short stem: A short-term follow-up study. World J Orthop. 2020;5836(4).
42. Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern. Clin Orthop Relat Res. 2017;475(2):375–83.
43. Kutzner KP, Donner S, Loweg L, Rehbein P, Dargel J, Drees P, et al. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol. 2019;20(1).
44. Kobayashi A, Donnelly WJ, Scott G, Freeman MAR. Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Jt Surg - Ser B. 1997;79(4):583–9.
45. Karrholm J, Borssen B, Lowenhielm G, Snorrason F. Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br. 1994 Nov 1;76-B(6):912–7.
46. Hochreiter J, Mattiassich G, Ortmaier R, Steinmair M, Anderl C. Femoral bone remodeling after short-stem total hip arthroplasty: a prospective densitometric study. Int Orthop. 2020;44(4):753–9.
47. Slullitel P, Mahatma M, Farzi M, Grammatopoulos G, Wilkinson J, Beaulé P. Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial. J Bone Jt Surg. 2020 Oct 20;Publish Ah.
48. Maier MW, Streit MR, Innmann MM, Krüger M, Nadorf J, Kretzer JP, et al. Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up Orthopedics and biomechanics. BMC Musculoskelet Disord. 2015;16(1):1–9.
49. Sariali E, Catonne Y, Pascal-Moussellard H. Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop. 2017;41(4):699–705.
50. Tostain O, Debuyzer E, Benad K, Putman S, Pierache A, Girard J, et al. Ten-year outcomes of cementless anatomical femoral implants after 3D computed tomography planning. Follow-up note. Orth
Published
2022-03-24
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Review
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