Suksathien Y, Chuvanichanon P, Tippimanchai T, Sueajui J. Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty. World J Orthop 2022; 13(5): 444-453 [PMID: 35633743 DOI: 10.5312/wjo.v13.i5.444]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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/
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
ARTICLE HIGHLIGHTS
Research background
Many previous studies have shown satisfactory results using conventional total hip arthroplasty (THA), there may have some clinical problems related to proximodistal dimensional mismatch, thigh pain, stress shielding, periprosthetic fracture and difficulty during removal when revision is necessary. In an effort to reduce these problems, short-stem THA was developed, because the short stem has a metaphyseal fitting and no diaphyseal anchoring, so these problems may be minimized.
Research motivation
Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal fitting without diaphyseal anchoring, they might demonstrate different subsidence patterns than with the conventional stems.
Research objectives
This study aimed to analyze the influencing factors with subsidence in short stems.
Research methods
Retrospectively reviewed the digitized radiographs of 274 consecutive short stem total hip arthroplasties. Subsidence, neck-filling ratio, 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 subsidence.
Research results
In this study we demonstrated that the insufficient lateral stem contact group (≥ 1 mm) seemed to have higher subsidence than the sufficient lateral stem contact group (< 1 mm) in the entire cohort, but did not reach statistical significance. For significant subsidence cohort, the only significant influencing factor was insufficient lateral stem contact, the univariate and multivariate regression analyses showed statistical significance.
Research conclusions
Insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence when using short stem. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the Metha stem THA.
Research perspectives
Long term follow-up for this study group will be the next study.
