Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs.

IF 1.9 2区医学 Q2 ORTHOPEDICS

Clinics in Orthopedic Surgery Pub Date : 2024-04-01 Epub Date: 2024-02-26 DOI:10.4055/cios23268

Seok Ha Hong, Seung Beom Han

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Abstract

Background: Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years.

Methods: Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared.

Results: Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS.

Conclusions: The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.

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多尔 A 型股骨中短股骨柄存活率的中期比较分析

背景：近端-远端不匹配已成为 Dorr A 型股骨形态的一个突出问题，促使人们探索用短股骨柄替代传统股骨柄。本研究旨在评估Dorr A型股骨近端形态使用短股骨柄进行全髋关节置换术（THA）的临床和影像学结果，随访时间至少5年：纳入2011年至2017年间使用Dorr A型短股骨柄的患者。根据年龄、性别、体重指数、髋臼与股骨管比率和诊断，招募了使用短模块化股骨柄（SMF）和Metha股骨柄的患者和使用缩短锥形股骨柄（Tri-Lock BPS）的患者进行倾向评分匹配。术后5年对患者报告的结果和大腿疼痛情况进行评估。此外，还对翻修率、并发症发生率和放射学结果进行了评估和比较：22例（81%）SMF骨干和43例（65%）Metha骨干有超过5年的随访数据。SMF骨干的失败率高于其他两组，18%的SMF骨干需要进行翻修手术，而Metha骨干为4.6%，Tri-Lock BPS为2.3%。SMF骨干出现了相当多的并发症，如骨干位置改变和外侧皮质肥厚，临床效果不如其他两组骨干。将Metha骨干组和Tri-Lock BPS组进行比较，发现Metha骨干组术中骨折较多，而Tri-Lock BPS组应力屏蔽和大腿前侧疼痛明显较多：结论：SMF柄的可靠性可能不如之前报道的那么高，显示出较高的失败率和较多的放射并发症。因此，将其用于Dorr A型股骨的THA需要谨慎。另一方面，Metha柄显示出与缩短的锥形Tri-Lock BPS相当的结果。

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