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Off-the-shelf femoral stems provide reliable fixation, results similar to custom stems
Off-the-shelf short femoral stems created to fit and fill the metaphysis provided up to 8 years of reliable fixation, with clinical and radiographic results that were similar to a custom implant, according to study results.
Researchers prospectively compared 148 hips of 139 patients treated with an off-the-shelf, uncemented metaphyseal-engaging stem with 69 hips of 61 patients treated with custom uncemented metaphyseal-engaging short stems. The researchers collected data including intraoperative and postoperative complications, need for revision surgery, and preoperative and postoperative clinical data, as well as a digital analysis of AP and lateral X-rays. Patients underwent clinical and radiographic examination at 4 weeks postoperatively, with subsequent follow-up at 3, 6 and 12 months and once per year thereafter.
The researchers calculated the Harris Hip score (HHS) and WOMAC pain scores, and patients’ preoperative radiographs were given a Dorr classification based on the bone quality. Implant stability and alignment were also measured with postoperative radiographs.
Results showed the mean HHS scores in the off-the-shelf stem group and the custom group were 94 and 96, respectively. Mean WOMAC scores for the off-the-shelf stem group and the custom group were 3 and 4, respectively. Both groups improved significantly compared with preoperative scores, according to the researchers.
The researchers found all implants had radiographic evidence of bony in-growth. No significant differences were observed between Dorr Type C radiographic results and those with Dorr Types A and B with regard to the HHS and WOMAC scores. Complications were found in both groups, with six in the off-the-shelf group and two in the custom group.
The HHS and WOMAC scores were not significantly different between stems placed in varus and those placed in neutral or slight valgus.
No revisions for aseptic loosening were needed for either group. The complication rate overall was 45% in the off-the-shelf group and 3% in the custom stem group, according to the researchers. ‒ by Monica Jaramillo
Disclosures: Chow reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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Chow I, et al. J Arthroplasty. 2015;doi:10.1016/j.arth.2014.01.003.