A Differentiated View on Short Stemmed Hip Arthroplasty – What are the Differences in Fixation and Biomechanics?

Abstract

The present paper gives an overview of the different types of short stem total hip replacements. There is a pronounced inhomogeneity of the nomenclature in clinical practice as well as in regard to the scientific literature. Examples include neck preserving implants, meta-, epi- or metadiaphyseal fixed implants, microimplants, ultrashort implants, partial neck preserving implants, trochanteric sparing implants, implants with extra- and/or intramedullar fixation, implants without primary fixation, etc. Biomechanically, the short stems vary from very short, completely neck retaining versions up to implants which are just a shorter version of a standard implant. A frequently cited classification recommends the osteotomy level as a discriminating factor. This classification categorizes into a neck preserving, partial neck preserving and neck resecting short stems.

Key words

primary hip arthroplasty - short stemmed endoprosthesis - hip arthroplasty classifications - biomechanics

• References/Literatur

• 1 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370: 1508-1519
• 2 Grimberg A, Jansson V, Liebs T. et al. EPRD-Jahresbericht: Endoprothesenregister Deutschland. Jahresbericht 2016. Im Internet: https://www.eprd.de/de/ueber-uns/publikationen/ Stand: 24.02.2019
• 3 Heller KD, Windhagen H. Pressemitteilung der Deutschen Gesellschaft für Endoprothetik e.V. (AE) am 1./2. Dezember 2017 in Hamburg und Pressekonferenz am 30. November 2017: Schlüssellochchirurgie und weniger Abrieb – Schonender Hüftgelenksersatz bei jungen Patienten. Freiburg, Hamburg, November/Dezember 2017. Im Internet: https://www.ae-germany.com/die-ae/presse/ae-pressemeldungen Stand: 24.02.2019
• 4 Salemyr M, Muren O, Ahl T. et al. Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional sten im uncemented total hip arthroplasty. Acta Orthop 2015; 86: 659-666
• 5 Yamako G, Chosa E, Totoribe K. et al. Trade-off between stress shielding and initial stability on an anatomical cementless stem shortening; in-vitro biomechanical study. Med Eng Phys 2015; 37: 820-825
• 6 Weber M, Woerner M, Springorum R. et al. Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA. Clin Orthop Relat Res 2014; 472: 3150-3158
• 7 Kutzner KP, Kovacevic MP, Roeder C. et al. Reconstruction of femoro-acetabular offsets using a short-stem. Int Orthop 2015; 39: 1269-1275
• 8 Jerosch J, Grasselli C, Kothny PC. et al. [Reproduction of the anatomy (offset, CCD, leg length) with a modern short stem hip design – a radiological study]. Z Orthop Unfall 2012; 150: 20-26
• 9 Jerosch J. [Differences between short stem prostheses]. Orthopade 2014; 43: 783-795
• 10 Babisch J. Möglichkeiten der patientenindividuellen Hüftgelenkrekonstruktion und Knochenresektion bei Kurzschaftprothesen. In: Jerosch J. Hrsg. Kurzschaftendoprothesen – Wo liegen die Unterschiede?. Köln: Deutscher Ärzteverlag; 2013: 193-227
• 11 Jerosch J, Funken S. [Change of offset after implantation of hip alloarthroplasties]. Unfallchirurg 2004; 107: 475-482
• 12 Edeen J, Sharkey PF, Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop 1995; 24: 347-351
• 13 Basad E, Ishaque B, Stürz H. et al. The anterolateral minimally invasive approach for total hip arthroplasty: technique, pitfalls, and way out. Orthop Clin North Am 2009; 40: 473-478
• 14 Jerosch J, Stobbe S, Schmid G. et al. Prospektive, randomisierte Studie zwischen Bauer- und ALMI-Zugang unter Berücksichtigung von MRI-Befunden und muskelspezifischen Blutparametern. Z Orthop Unfall 2012; 150: 615-623
• 15 Castelli CC, Rizzi L. Short stems in total hip replacement: current status and future. Hip Int 2014; 24 (Suppl. 10) S25-S28
• 16 Jerosch J. Ist kürzer wirklich besser? Philosophie der Kurzschaftendoprothesen. Orthopäde 2011; 40: 1075-1083
• 17 Schnurr C, Schellen B, Dargel J. et al. Low short-stem revision rates: 1–11 year results from 1888 total hip arthroplasties. J Arthroplasty 2017; 32: 487-493
• 18 von Lewinski G, Floerkemeier T. 10-year experience with short stem total hip arthroplasty. Orthopedics 2015; 38: 51-56
• 19 von Engelhardt LV, Breil-Wirth A, Kothny C. et al. Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHipTM). World J Orthop 2018; 9: 210-219
• 20 Giardina F, Castagnini F, Stea S. et al. Short stems versus conventional stems in cementless total hip arthroplasty: a long-term registry study. J Arthroplasty 2018; 33: 1794-1799
• 21 Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics 2015; 38: 6-13
• 22 Khanuja HS, Banerjee S, Jain D. et al. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014; 96: 1742-1752
• 23 Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement?. Bone Joint J 2014; 96: 442-448
• 24 Morlock M, Bichop N. Zur Biomechanik von Kurzschaftprothesen. Orthopädie im Profil 2011; 1: 10-11
• 25 Stukenborg-Colsman C. Schenkelhalsendoprothesen. Orthopäde 2007; 36: 347-352
• 26 Jerosch J. Kurzschaft ist nicht gleich Kurzschaft – Eine Klassifikation der Kurzschaftprothesen. OUP 2012; 1: 304-312
• 27 Jerosch J. Kurzschaftendoprothesen. Wo liegen die Unterschiede?. Köln: Deutscher Ärzte-Verlag; 2012
• 28 Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br 2000; 82: 952-958
• 29 Jerosch J, Grasselli C, Kothny PC. et al. Postoperative Veränderungen von Offset, CCD-Winkel und Beinlänge nach Implantation einer metadiaphysär fixierten Kurzschaftprothese – eine radiologische Untersuchung. Z Orthop Unfall 2012; 150: 20-26
• 30 Pfeil J. Comment je pose la prothèse optimys. Maitrise Orthop 2014; 236 Im Internet: https://www.maitrise-orthopedique.com/articles/comment-je-pose-la-prothese-optimys-224 Stand: 24.02.2019;
• 31 Kutzner KP, Pfeil J. Individualized stem-positioning in calcar-guided short-stem total hip arthroplasty. J Vis Exp 2018; 132: 56905
• 32 Pfeil J, Siebert W. Minimally invasive Surgery in total Hip Arthroplasty. Berlin, Heidelberg: Springer; 2010
• 33 Jerosch J. Kurzschaftprothesen an der Hüfte. Berlin: Springer; 2017
• 34 Ettinger M, Ettinger P, Ezechieli M. et al. CCD and offset after Nanos short stem in total hip arthroplasty. Technol Health Care 2013; 21: 149-155
• 35 Kutzner KP, Kovacevic MP, Freitag T. et al. Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA. J Orthop Surg Res 2016; 11: 29
• 36 Windhagen H, Chincisan A, Choi HF. et al. Soft-tissue balance in short and straight stem total hip arthroplasty. Orthopedics 2015; 38: 14-20
• 37 Bieger R, Ignatius A, Decking R. et al. Primary stability and strain distribution of cementless hip stems as a function of implant design. Clin Biomech (Bristol, Avon) 2012; 27: 158-164
• 38 Freitag T, Kappe T, Fuchs M. et al. Migration pattern of a femoral short-stem prosthesis: a 2-year EBRA-FCA-study. Arch Orthop Trauma Surg 2014; 134: 1003-1008
• 39 Budde S, Seehaus F, Schwarze M. et al. Analysis of migration of the Nanos^® short-stem hip implant within two years after surgery. Int Orthop 2016; 40: 1607-1614
• 40 Ercan A, Sokkar SM, Schmid G. et al. Periprosthetic bone density changes after MiniHip^™ cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study. SICOT J 2016; 2: 40
• 41 Bishop NE, Burton A, Maheson M. et al. Biomechanics of short hip endoprostheses–the risk of bone failure increases with decreasing implant size. Clin Biomech (Bristol (Avon) 2010; 25: 666-674
• 42 Wolff J. Das Gesetz der Transformation der Knochen. In: Wessinghage D. Hrsg. Reprints medizinhistorischer Schriften, 4. Stuttgart: Schattauer; 1982
• 43 Robinson RP, Lovell TP, Green TM. Hip arthroplasty using the cementless CLS stem. A 2–4-year experience. J Arthroplasty 1994; 9: 177-192
• 44 Bergschmidt P, Bader R, Finze S. et al. Cementless total hip replacement: a prospective clinical study of the early functional and radiological outcomes of three different hip stems. Arch Orthop Trauma Surg 2010; 130: 125-133
• 45 Lerch M, von der Haar-Tran A, Windhagen H. et al. Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop 2012; 36: 533-538
• 46 Zeh A, Pankow F, Röllinhoff M. et al. A prospective dual-energy X-ray absorptiometry study of bone remodeling after implantation of the Nanos short-stemmed prosthesis. Acta Orthop Belg 2013; 79: 174-180
• 47 Shafy TA, Sayed A, Abdelazeem AH. Study of the bone behavior around a neck preserving short stem implant: bone densitometric analysis over a span of two years. SICOT J 2016; 2: 31
• 48 Banerjee S, Pivec R, Issa K. et al. Outcomes of short stems in total hip arthroplasty. Orthopedics 2013; 36: 700-707