Surgeon explores use of short femoral stems for young osteoarthritic patients

A minimum 2-year follow-up of a prototype series showed no failures and one dislocation.

ORLANDO, Fla. — Using short cementless femoral stems in young, active patients may lead to bone remodeling while avoiding proximal-distal mismatch, according to a surgeon speaking here.

"I think surface replacements do not need to be considered when stems are good," S. David Stulberg, MD, said in a presentation at the 24th Annual Current Concepts in Joint Replacement Winter 2007 Meeting. "Save your surface treatment for where you need it."

In a prototype series of 72 consecutive primary total hip arthroplasties (THAs), Stulberg fitted young, active patients with custom implants featuring stems less than 100-mm long.

All patients had osteoarthritis and averaged 55.3 years of age at surgery, according to the study abstract.

A minimum 2-year follow-up revealed no failures and only one dislocation due to a problem with the prosthesis' cup. Also, 1-year follow-up showed bone ingrowth on all stems and no instances of subsidence, according to the study.

"[In] women who are osteopenic, there have been no problems with guarded bone remodeling or fixation," Stulberg said. "So it seems as though the concept makes sense for this type of a design and we may be able to reap some of the benefits of this kind of concept, particularly if we move into different minimally invasive approaches."

Stulberg noted that future stems could have extensive proximal contact or modular designs. Potential advantages include the possibility for using various stem head sizes, instrumentation for different surgical approaches and stems for revision cases, he said.

For more information:
Stulberg SD. The short stem: A thinking man's alternative to surface replacement. #12. Presented at the 24th Annual Current Concepts in Joint Replacement Winter 2007 Meeting. Dec. 12-17, 2007. Orlando, Fla.