Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty

doi:10.5312/wjo.v13.i5.444

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Study

World J Orthop. May 18, 2022; 13(5): 444-453
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.444

Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty

Yingyong Suksathien, Pattawat Chuvanichanon, Thanut Tippimanchai, Jithayut Sueajui

Yingyong Suksathien, Pattawat Chuvanichanon, Thanut Tippimanchai, Jithayut Sueajui, Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand

Author contributions: All authors contributed to the study conception and design; Suksathien Y, Chuvanichanon P and Tippimanchai T contributed to the material preparation, data collection and performed analysis; Suksathien Y wrote the first draft of the manuscript; and all authors commented on previous versions of the manuscript and read and approved the final manuscript.

Institutional review board statement: This study was Approval by the Institutional Review Board of Maharat Nakhon Ratchasima Hospital, Thailand (Approval No. 046/2021).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.

Data sharing statement: No additional data are available.

Corresponding author: Yingyong Suksathien, MD, Doctor, Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd., Mueang District, Muang 30000, Nakhon Ratchasima Province, Thailand. ysuksathien@yahoo.com

Received: October 8, 2021
Peer-review started: October 8, 2021
First decision: January 12, 2022
Revised: January 25, 2022
Accepted: April 29, 2022
Article in press: April 29, 2022
Published online: May 18, 2022
Processing time: 216 Days and 23.2 Hours

ARTICLE HIGHLIGHTS

Research background

Many previous studies have shown satisfactory results using conventional total hip arthroplasty (THA), there may have some clinical problems related to proximodistal dimensional mismatch, thigh pain, stress shielding, periprosthetic fracture and difficulty during removal when revision is necessary. In an effort to reduce these problems, short-stem THA was developed, because the short stem has a metaphyseal fitting and no diaphyseal anchoring, so these problems may be minimized.

Research motivation

Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal fitting without diaphyseal anchoring, they might demonstrate different subsidence patterns than with the conventional stems.

Research objectives

This study aimed to analyze the influencing factors with subsidence in short stems.

Research methods

Retrospectively reviewed the digitized radiographs of 274 consecutive short stem total hip arthroplasties. Subsidence, neck-filling ratio, seating height and lateral stem contact were evaluated after a minimum of two years follow-up. A threshold of subsidence > 3 mm was considered a clinically significant subsidence.

Research results

In this study we demonstrated that the insufficient lateral stem contact group (≥ 1 mm) seemed to have higher subsidence than the sufficient lateral stem contact group (< 1 mm) in the entire cohort, but did not reach statistical significance. For significant subsidence cohort, the only significant influencing factor was insufficient lateral stem contact, the univariate and multivariate regression analyses showed statistical significance.

Research conclusions

Insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence when using short stem. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the Metha stem THA.

Research perspectives

Long term follow-up for this study group will be the next study.