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Ultra-short anatomic cementless stem provides stable fixation at 7 years postop
The components studied produced stable fixation in younger and elderly patients who underwent THA.
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LONDON — Despite concerns that ultra-short anatomic cementless total hip arthroplasty femoral stems may not result in good outcomes in both older and young patients, a study that reviewed 200 cases when metaphyseal-fitting prostheses showed it helped treat a wide range of patients.
Jang-Won Park, MD, presented the findings at the 15th EFORT Congress — a combined programme in partnership with the BOA.
The study included 200 patients with 226 hips overall who underwent total hip arthroplasty (THA) with the DePuy Proxima prosthesis, a cementless ultra-short anatomic metaphyseal-fitting femoral stem. The study investigated whether the prostheses provided similar outcomes and functional improvement in both younger and elderly patients.
Image: Kim Y-H
Results analyzed by age
“We also tried to see if radiographically secure implant fixation would be achieved with this ultra-short stem in both younger and elderly patients, and also to do the [bone mineral density] BMD studies,” first author of the study Young-Hoo Kim, MD, said. “We also checked to see if there were any more complications in the older groups.”
One hundred patients (114 hips) under 65 years old were included in the study, as well as 100 patients aged 65 years or older (112 hips). The mean age in the younger group was 44 years (range 31 years to 50 years). The mean age in the elderly group was 79 years (range 66 years to 91 years. The patients’ weight and height were similar in both groups.
“The most common indication for surgery for the younger group was osteonecrosis,” Kim said.
Considerably more of the elderly patients underwent THA for femoral neck fractures in the study, he said. The average follow-up was 7.5 years for the younger group and 7.6 years for the elderly group.
According to Kim, the Harris Hip Scores, WOMAC scores, thigh pain and the radiographic scores were not significantly different between the two groups at final follow-up. The UCLA activity scores at follow-up were statistically significantly different. On the UCLA scale, the younger group averaged 6.5 points compared to the elderly group, which averaged 4.3 points.
Improved postoperative outcomes
After analyzing the surgical outcomes, no hips in either group had clicking or squeaking sounds, ceramic fractures of any kind or aseptic loosening. However, one hip per group had some migration, but this eventually stabilized. Two hips in the elderly group (1.8%) needed a cup revision, Kim said.
Based on this study, the ultra-short stems provided good health outcomes across both groups, he said.
“Ultra-short metaphyseal fitting anatomic cementless femoral components provide stable fixation without diaphyseal fixation in both younger and elderly patients. Despite the concern, poor bone quality of elderly patients does not compromise the stability and osseointegration of ultra-short stems,” Kim said. – by Robert Linnehan
- Reference:
- Kim Y-H. Paper #1974. Presented at: 15th EFORT Congress — a combined programme in partnership with the BOA; 4-6 June 2014; London.
- For more information:
- Young-Hoo Kim, MD, can be reached at The Joint Replacement Center, Ewha Women’s University School of Medicine, 11-1, Daehyeon-dong, Seodaemun-gu, Seoul, Korea; email: younghookim@ewha.ac.kr.
- Jang-Won Park, MD, can be reached at The Joint Replacement Center, Ewha Women’s University School of Medicine, 11-1, Daehyeon-dong, Seodaemun-gu, Seoul, Korea; email: jwpark.md@gmail.com.
Disclosures: Kim and Park have no relevant financial disclosures.