IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy.
Arch Orthop Trauma Surg. 2024 Jan;144(1):425-431. doi: 10.1007/s00402-023-05012-8. Epub 2023 Aug 1.
There is growing interest around short stems as they provide a less invasive approach for total hip arthroplasty preserving bone stock for a possible revision surgery if required. The main purpose of this work was to assess the long-term performance of an uncemented metaphyseal short stem in terms of survival rate and in addition its clinical and radiological outcomes.
From January to December 2010, we prospectively enrolled all consecutive patients undergoing primary total hip arthroplasty with an uncemented metaphyseal short stem in our institution with a minimum follow-up of 10 years. The radiographic features investigated were the varus-valgus stem orientation, areas of osteolysis and radiolucencies, stress shielding, and heterotopic calcifications. The clinical outcomes were measured using the HHS.
A total of 163 patients (172 hips) were finally included and the measured survival rate at 10 years was 99.6%. The average HHS increased from 55.0 preoperatively to 97.8 at the last follow-up (p < 0.0001). Among them, 137 patients (164 hips) were also available for radiographic assessment. Mild varus malalignment was observed in 40% of cases and remained stable in the serial X-rays and was not associated with step loosening. Mild stress shielding was observed around 13 stems (9%) and moderate only around 3 implants.
In conclusion, the uncemented metaphyseal short stems showed excellent survival and clinical results at 10 years and at a radiographical level very low stress shielding was observed; moreover, besides the high frequency of varus alignment the implanted stems was not associated with revision surgery or with worse clinical outcomes.
短柄假体越来越受到关注，因为它们为全髋关节置换术提供了一种微创入路，可以保留骨量，如果需要进行翻修手术。本研究的主要目的是评估非骨水泥干骺端短柄在生存率方面的长期疗效，并评估其临床和影像学结果。
2010 年 1 月至 12 月，我们前瞻性地纳入了在我院接受非骨水泥干骺端短柄初次全髋关节置换术的所有连续患者，随访时间至少 10 年。研究的影像学特征包括：矢状面和冠状面的柄位、骨溶解和透亮区、应力遮挡、异位骨化。临床结果采用 HHS 进行评估。
共纳入 163 例患者（172 髋），10 年的测量生存率为 99.6%。术前 HHS 平均为 55.0 分，末次随访时增加至 97.8 分（p<0.0001）。其中，137 例患者（164 髋）的影像学资料也可用。40%的病例存在轻度内翻畸形，在连续 X 线片中保持稳定，与台阶松动无关。约 13 枚（9%）柄周围出现轻度应力遮挡，3 枚（2%）仅出现中度应力遮挡。
总之，非骨水泥干骺端短柄在 10 年时具有良好的生存率和临床结果，在影像学水平上仅观察到轻度的应力遮挡；此外，除了高频率的内翻外，植入的柄与翻修手术或较差的临床结果无关。
