Download PDF
The Journal of Hip Surgery 2024; 08(03): 125-133
DOI: 10.1055/s-0044-1800908
Review Article

Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits

Zementfreie Kurzschaftprothesen in der Hüftendoprothetik: Möglichkeiten und Limits
Yama Afghanyar 
1   Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
,
Karl Philipp Kutzner 
1   Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
2   Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
,
Joachim Pfeil
1   Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
,
Philipp Drees
2   Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
,
Philipp Rehbein
1   Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
,
Jens Dargel
1   Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.

Zusammenfassung

In den letzten Jahrzehnten ist eine Vielzahl von zementfreien Kurzschaftprothesen auf den Markt gekommen. Gemeinsam vereinen sie das Ideal der weichteilschonenden und minimalinvasiven Hüftgelenksendoprothetik mit knochensparenden Implantationstechniken. Hervorzuheben ist die neueste Generation von Kurzschaftprothesen, die schenkelhalsteilerhaltend und kalkargeführt in einer Round-the-Corner-Technik implantiert werden. Die patientenadaptierte Resektionsebene ergibt die Möglichkeit für eine variable Positionierung des Implantates und eine optimale Rekonstruktion der individuellen Hüftgeometrie. Die vielversprechende frühe Datenlage in der primären hüftendoprothetischen Versorgung führt zunehmend zu einer Ausweitung der Möglichkeiten und Grenzen des Kurzschaftes. Insbesondere die individuelle Positionierung in Valgus- oder Varusposition und die resultierende individuelle metaphysäre oder metadiaphysäre Verankerung eröffnet zahlreiche Möglichkeiten, auch abweichende anatomische Hüftgelenksvarianten optimal rekonstruieren zu können. Zunehmend finden daher Kurzschaftprothesen auch Einsatz bei Patienten mit komplexen anatomischen Variationen, Anomalien oder auch bei aseptischen Hüftkopfnekrosen. In Einzelfällen werden sie auch in der Revisions- oder Konversionsendoprothetik eingesetzt. In bestimmten Einzelfällen können diese Implantate auch in der Frakturendoprothetik eingesetzt werden. Wissenschaftliche Untersuchungen hierzu stehen gegenwärtig jedoch noch aus.

Keywords

short stem - total hip arthroplasty - cementless

Schlüsselwörter

Kurzschaftprothese - Hüfttotalendoprothese - Zementfrei

* This article is a republished version of: Afghanyar Y, Kutzner KP, Pfeil J, Drees P, Rehbein P, Dargel J. Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits. Z Orthop Unfall 2023;161(4):396–404.




Publication History

Article published online:
09 January 2025

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jerosch J. Kurzschaftendoprothesen an der Hüfte. Heidelberg: Springer; 2016.
    CrossrefSearch in Google Scholar
  • 2 Endoprothesenregister Deutschland. Jahresbericht 2020. Mit Sicherheit mehr Qualität. 2020 Im Internet (Stand: 10.10.2021): https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/Jahresbericht2020-Web_2020–12–11_F.pdf
    PubMedSearch in Google Scholar
  • 3 Chidambaram R, Cobb AG. Change in the Age Distribution of Patients Undergoing Primary Hip and Knee Replacements Over 13 Years – an Increase in the Number of Younger Men Having Hip Surgery. Orthop Proc 2009; 91-B (Suppl. 01) 152
    PubMedSearch in Google Scholar
  • 4 Pfeil J, Siebert W. Minimally Invasive Surgery in Total Hip Arthroplasty. Heidelberg: Springer; 2010.
    CrossrefSearch in Google Scholar
  • 5 Jerosch J. Unterschiede zwischen verschiedenen Kurzschaftendoprothesen. Orthopäde 2014; 43: 783-796
    CrossrefPubMedSearch in Google Scholar
  • 6 Kutzner KP. Calcar-guided short-stem total hip arthroplasty: Will it be the future standard? Review and perspectives. World J Orthop 2021; 12: 534
    CrossrefPubMedSearch in Google Scholar
  • 7 Jerosch J. Kurzschaft ist nicht gleich Kurzschaft—Eine Klassifikation der Kurzschaftprothesen. OUP 2012; 1: 304-312
    CrossrefPubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics 2015; 38 (3 Suppl.): S6-S13
    CrossrefPubMedSearch in Google Scholar
  • 10 Kutzner KP, Donner S, Loweg L. et al. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol 2019; 20: 31
    CrossrefPubMedSearch in Google Scholar
  • 11 Kutzner KP, Ried E, Donner S. et al. Mid-term migration pattern of a calcar-guided short stem: A five-year EBRA-FCA-study. J Orthop Sci 2020; 25: 1015-1020
    CrossrefPubMedSearch in Google Scholar
  • 12 Mai S, Pfeil J, Siebert W. et al. Calcar-guided short stems in total hip arthroplasty–an overview. OUP 2016; 6: 342-347
    PubMedSearch in Google Scholar
  • 13 Loweg L, Kutzner KP, Trost M. et al. The learning curve in short-stem THA: influence of the surgeon's experience on intraoperative adjustments due to intraoperative radiography. Eur J Orthop Surg Traumatol 2018; 28: 269-275
    CrossrefPubMedSearch in Google Scholar
  • 14 Coutandin M, Afghanyar Y, Drees P. et al. Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients. J Orthop 2021; 24: 274-279
    CrossrefPubMedSearch in Google Scholar
  • 15 Bostian PA, Grisez BT, Klein AE. et al. Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges. Arthroplast Today 2021; 8: 150-156
    CrossrefPubMedSearch in Google Scholar
  • 16 Coutandin M, Afghanyar Y, Rehbein P. et al. Downsizing in total hip arthroplasty. A short stem as a revision implant. Orthopade 2022; 51 (03) 230-238
    CrossrefPubMedSearch in Google Scholar
  • 17 Bayliss LE, Culliford D, Monk AP. et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017; 389: 1424-1430
    CrossrefPubMedSearch in Google Scholar
  • 18 Kutzner KP, Kovacevic MP, Roeder C. et al. Reconstruction of femoro-acetabular offsets using a short-stem. Int Orthop 2015; 39: 1269-1275
    CrossrefPubMedSearch in Google Scholar
  • 19 Bieger R, Ignatius A, Reichel H. et al. Biomechanics of a short stem: in vitro primary stability and stress shielding of a conservative cementless hip stem. J Orthop Res 2013; 31: 1180-1186
    CrossrefPubMedSearch in Google Scholar
  • 20 Yan SG, Weber P, Steinbrück A. et al. Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. Int Orthop 2018; 42: 2077-2086
    CrossrefPubMedSearch in Google Scholar
  • 21 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
    CrossrefPubMedSearch in Google Scholar
  • 22 de Waard S, Sierevelt IN, Jonker R. et al. The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA. Hip Int 2021; 31: 507-515
    CrossrefPubMedSearch in Google Scholar
  • 23 Kutzner KP, Donner S, Schneider M. et al. One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty. Oper Orthop Traumatol 2017; 29: 180-192
    CrossrefPubMedSearch in Google Scholar
  • 24 Jerosch J, von Engelhardt LV. A Differentiated View on Short Stemmed Hip Arthroplasty–What are the Differences in Fixation and Biomechanics?. Z Orthop Unfall 2019; 157: 548-557
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Kurzschaftendoprothesen: wo liegen die Unterschiede?. Jerosch J. Köln: Deutscher Ärzteverlag; 2012
    Search in Google Scholar
  • 27 Kutzner KP, Freitag T, Donner S. et al. Outcome of extensive varus and valgus stem alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA. Arch Orthop Trauma Surg 2017; 137: 431-439
    CrossrefPubMedSearch in Google Scholar
  • 28 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 2011; 150: 20-26
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement?. Bone Joint J 2014; 96: 442-448
    CrossrefPubMedSearch in Google Scholar
  • 30 Ishaque BA, Donle E, Gils J. et al. Eight-year results of the femoral neck prosthesis ESKA-CUT. Z Orthop Unfall 2009; 147: 158-165
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Nieuwenhuijse MJ, Valstar ER, Nelissen RG. 5-year clinical and radiostereometric analysis (RSA) follow-up of 39 CUT femoral neck total hip prostheses in young osteoarthritis patients. Acta Orthop 2012; 83: 334-341
    CrossrefPubMedSearch in Google Scholar
  • 32 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
    CrossrefPubMedSearch in Google Scholar
  • 33 Kohler S, Ratayski H, Zacher J. Implant-related fractures of the femoral neck cone adapter of a modular short-stem hip prosthesis-patient management and operative technique. Z Orthop Unfall 2010; 149: 185-190
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 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
    CrossrefPubMedSearch in Google Scholar
  • 35 Malahias MA, Tejaswi P, Chytas D. et al. The clinical outcome of the Metha short hip stem: a systematic scoping review. Hip Int 2021; 31: 24-33
    CrossrefPubMedSearch in Google Scholar
  • 36 Kendoff DO, Citak M, Egidy CC. et al. Eleven-year results of the anatomic coated CFP stem in primary total hip arthroplasty. J Arthroplasty 2013; 28: 1047-1051
    CrossrefPubMedSearch in Google Scholar
  • 37 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
    CrossrefPubMedSearch in Google Scholar
  • 38 Afghanyar Y, Danckwardt C, Schwieger M. et al. Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA. Arch Orthop Trauma Surg 2020; 140: 2091-2100
    CrossrefPubMedSearch in Google Scholar
  • 39 Kutzner KP, Pfeil J. Individualized stem-positioning in calcar-guided short-stem total hip arthroplasty. J Vis Exp 2018; (132) 56905
    CrossrefPubMedSearch in Google Scholar
  • 40 Kutzner KP, Pfeil D, Kovacevic MP. et al. Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases. Hip Int 2016; 26: 278-283
    CrossrefPubMedSearch in Google Scholar
  • 41 Schmidutz F, Graf T, Mazoochian F. et al. Migration analysis of a metaphyseal anchored short-stem hip prosthesis: EBRA-FCA evaluation of 80 implants with a minimum follow-up time of 2 years. Acta Orthop 2012; 83: 360-365
    CrossrefPubMedSearch in Google Scholar
  • 42 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
    CrossrefPubMedSearch in Google Scholar
  • 43 Ferguson RJ, Broomfield JA, Malak TT. et al. Primary stability of a short bone-conserving femoral stem: a two-year randomized controlled trial using radiostereometric analysis. Bone Joint J 2018; 100: 1148-1156
    CrossrefPubMedSearch in Google Scholar
  • 44 Kutzner KP, Freitag T, Bieger R. Defining ‘undersizing’ in short-stem total hip arthroplasty: the importance of sufficient contact with the lateral femoral cortex. Hip Int 2022; 32 (02) 160-165
    CrossrefPubMedSearch in Google Scholar
  • 45 Jerosch J, Breil-Wirth A, Kothny C. et al. Schenkelhals-teilerhaltende Kurzschaftprothesen bewähren sich. Orthopädie & Rheuma 2019; 22: 39-43
    CrossrefPubMedSearch in Google Scholar
  • 46 Lerch M, Kurtz A, Windhagen H. et al. The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study. Int Orthop 2012; 36: 2211-2217
    CrossrefPubMedSearch in Google Scholar
  • 47 Lerch M, Kurtz A, Stukenborg-Colsman C. et al. Bone remodeling after total hip arthroplasty with a short stemmed metaphyseal loading implant: finite element analysis validated by a prospective DEXA investigation. J Orthop Res 2012; 30: 1822-1829
    CrossrefPubMedSearch in Google Scholar
  • 48 Jerosch J, Breil-Wirth A, Kothny C. et al. Hip replacement in young patients. OUP 2019; 8: 413-419
    PubMedSearch in Google Scholar
  • 49 Djebara AE, El Yagoubi A, Mertl P. et al. Comparison of periprosthetic bone mineral density between two types of short-stems in total hip arthroplasty with a mean follow-up of 4 years. Orthop Traumatol Surg Res 2022; 108 (01) 103044
    CrossrefPubMedSearch in Google Scholar
  • 50 Brinkmann V, Radetzki F, Delank KS. et al. A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses. J Orthop Traumatol 2015; 16: 237-243
    CrossrefPubMedSearch in Google Scholar
  • 51 Meyer JS, Freitag T, Reichel H. et al. Periprosthetic bone mineral density changes after implantation of a curved bone preserving hip stem compared to a standard length straight stem: 5-yr results of a prospective, randomized DXA-analysis. J Clin Densitom 2019; 22: 96-103
    CrossrefPubMedSearch in Google Scholar
  • 52 Yan SG, Di Li SY, Hua X. et al. Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty: a systematic review and meta-analysis of randomized-controlled trials. Medicine (Baltimore) 2017; 96: e8806
    CrossrefPubMedSearch in Google Scholar
  • 53 Gkagkalis G, Goetti P, Mai S. et al. Cementless short-stem total hip arthroplasty in the elderly patient-is it a safe option?: a prospective multicentre observational study. BMC Geriatr 2019; 19: 112
    CrossrefPubMedSearch in Google Scholar
  • 54 Windhagen H, Chincisan A, Choi HF. et al. Soft-tissue balance in short and straight stem total hip arthroplasty. Orthopedics 2015; 38 (Suppl. 03) S14-S20
    CrossrefPubMedSearch in Google Scholar
  • 55 Tohtz SW, Heller MO, Taylor WR. et al. Zur Biomechanik der Hüfte. Orthopäde 2008; 37: 923-930
    CrossrefPubMedSearch in Google Scholar
  • 56 Schneider M, Kutzner K, Walz A. et al. Individualised Therapy of femoral Neck Fractures – The Wiesbaden Concept. Maitrise Orthopedique 2018; 28-31
    PubMedSearch in Google Scholar