Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 444-453
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.444
Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty
Yingyong Suksathien, Pattawat Chuvanichanon, Thanut Tippimanchai, Jithayut Sueajui
Yingyong Suksathien, Pattawat Chuvanichanon, Thanut Tippimanchai, Jithayut Sueajui, Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
Author contributions: All authors contributed to the study conception and design; Suksathien Y, Chuvanichanon P and Tippimanchai T contributed to the material preparation, data collection and performed analysis; Suksathien Y wrote the first draft of the manuscript; and all authors commented on previous versions of the manuscript and read and approved the final manuscript.
Institutional review board statement: This study was Approval by the Institutional Review Board of Maharat Nakhon Ratchasima Hospital, Thailand (Approval No. 046/2021).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yingyong Suksathien, MD, Doctor, Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd., Mueang District, Muang 30000, Nakhon Ratchasima Province, Thailand. ysuksathien@yahoo.com
Received: October 8, 2021
Peer-review started: October 8, 2021
First decision: January 12, 2022
Revised: January 25, 2022
Accepted: April 29, 2022
Article in press: April 29, 2022
Published online: May 18, 2022
Processing time: 216 Days and 23.2 Hours
Abstract
BACKGROUND

Subsidence is one of the concerning early complications in cementless femoral stem. Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal anchoring without diaphyseal invasion, they might demonstrate different subsidence patterns than with the conventional stems.

AIM

To analyze the factors associated with significant subsidence in short stems, including any radiographic parameters.

METHODS

The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed. Subsidence, neck-filling ratio (NFR), seating height and lateral stem contact were evaluated after a minimum of two years follow-up. A threshold of subsidence > 3 mm was considered a clinically significant migration.

RESULTS

For the entire cohort, subsidence occurred in 75 cases (27.4%) with the mean stem subsidence of 0.5 mm. (0-12.7, 1.68). Twelve hips (4.4%) had significant subsidence (> 3 mm). The univariate regression analysis demonstrated that age, diagnosis, BMI, Dorr’s type B, NFR, and seating height had no significant influence on significant subsidence, whereas insufficient lateral stem contact (≥ 1 mm) did have a statistically significant influence [Odds ratio (OR) = 5.02; 95%CI: 1.3-18.9; P = 0.017]. The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor (OR = 5.5; 95%CI: 1.4-21.4; P = 0.014). There was no femoral stem revision for aseptic loosening in our cohort.

CONCLUSION

This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.

Keywords: Total hip arthroplasty; Short stem; Subsidence; Metaphyseal anchorage; Metha

Core Tip: Short stem total hip arthroplasties (THAs) are commonly used in young and active patients. The advantages of these stems include more proximal load transfer which reduces stress shielding and, thigh pain, and they provide better options should revision surgery become necessary. Subsidence is one of the concerning complications in cementless femoral fixation. It is particularly important to identify the key intraoperative decision criteria to predict post-implantation subsidence of the short stem, which should be useful for choosing the proper size and position of the short stem and for allowance of early weight bearing post-operatively. This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the short stem THA.