Abstract
Purpose
Limitations of standard-length femoral stems persist, including proximal-distal mismatch, non-ideal load transfer, loss of bone tissue, and perioperative fracture. Symbol® (Dedienne Santé, France) is a metaphyseal-engaging short-stem implant designed to address these issues in total hip arthroplasty (THA). While short stems have been well studied in selected and younger patients, it is unclear whether they offer advantages in an unselected population. We hypothesized that short femoral stems offer similar mid-term survivorship at five year minimum follow-up and function score to standard-length femoral stems, in an unselected patient population.
Methods
We retrospectively reviewed a continuous unselected cohort of patients who undergone THA by one surgeon with a standard-length stem between November 2013 and October 2015, and a short stem between November 2015 and March 2017. We compared modified Harris Hip Score and Oxford Scores with a minimum follow-up of five years and procedural factors that could be associated with worse results with a short stem design.
Results
There was no difference in survival rate between the two groups. Average Harris Hip Score and Oxford Scores at the last follow-up were comparable. A multivariate linear regression was performed to assess the relationship between modified Harrys Hip Score at five years post-operatively and the explanatory variables: age, body mass index, physical status score ASA (American Society of Anesthesiologists), and HHS pre-op. None was associated with the standard-length stem but for the short stem.
Conclusion
Short-stem implants provide good survival rate at mid-term; nevertheless, a steep learning curve is necessary to optimize the metaphyseal filling of the implant, especially for osteoporotic bone.
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Olivier Barbier: redaction
Gilles Estour: redaction
Robian Rassat: data collect
Alexandre Caubère: data analysis
Sonia Dubreuil: data collect
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Olivier Barbier: consulting for Arthrex and Dediène Santé. Gilles Estour: consulting for Dediène Santé. Robian Rassat, Alexandre Caubère, Sonia Dubreuil: no conflict of interest.
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Level III, therapeutic study.
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Barbier, O., Rassat, R., Caubère, A. et al. Short-stem total hip arthroplasty is equivalent to a standard-length stem procedure in an unselected population at mid-term follow-up. International Orthopaedics (SICOT) 48, 1017–1022 (2024). https://doi.org/10.1007/s00264-023-06020-4
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DOI: https://doi.org/10.1007/s00264-023-06020-4