Broach Only Total Hip Arthroplasty Using a Short, Uncemented, Collarless, Fit-and-Fill Stem: Average 5-year Follow-up.

Abstract

Introduction: Short femoral stem use in total hip arthroplasty (THA) can preserve bone stock and may diminish may thigh pain. Tapered-wedge short stems are appealing because reaming is not typically required as it is with classic "fit-and-fill" designed stems. This study aimed to evaluate the minimum 2-year clinical, radiographic, and clinical results of a short, uncemented, collarless, fit-and-fill stem implanted using a broach-only technique.

Methods: The clinical and radiographic results of a consecutive series of 505 cementless THAs were reviewed two to nine years postoperatively. The average age was 62 years (range, 32 to 91), and 54% of the patients were men. Dorr's class was 31% A, 64% B, and 5%C. All patients were followed for a minimum of two years. The average follow-up was 5.6 years (range, two to nine).

Results: At the final follow-up, the average Harris hip and pain scores were 90 and 42, respectively. There were 82% of hips were rated as pain-free. A single patient reported activity-related thigh pain. There were no cases of femoral aseptic loosening. At operation, 14% of stems were placed in more than five degrees of varus. An intraoperative femur fracture occurred in 13 hips (2.5%). There were two stems were revised (one infection and one late femur fracture).

Conclusion: The theoretical advantages of using this collarless fit-and-fill stem may be offset by the tendency for varus placement and proximal femur fracture when using a broach-only technique. Nevertheless, the varus stems in this series remain well-ingrown and radiographically stable at average five-year follow-up.