Native hip geometry restoration in total hip arthroplasty: a retrospective analysis of eight different short stems

• Published in: European journal of orthopaedic surgery & traumatology Vol. 34; no. 6; pp. 3309 - 3317
• Main Authors: Sinno, Ennio, Piccolo, Yuri, Scrivano, Marco, Rovere, Giuseppe, Damanti, Martina, Panegrossi, Gabriele
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.08.2024; Springer Nature B.V
• Subjects: Aged; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Female; Femur - anatomy & histology; Femur - diagnostic imaging; Femur - surgery; Geometry; Hip Joint - anatomy & histology; Hip Joint - diagnostic imaging; Hip Joint - surgery; Hip Prosthesis; Humans; Joint replacement surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prosthesis Design; Radiography - methods; Reproducibility; Reproducibility of Results; Retrospective Studies; Surgical Orthopedics; Traumatic Surgery; Hip osteoarthritis; Arthroplasty; Short stem; Total hip arthroplasty; Preoperative planning
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-024-04075-6

Purpose To compare different types of short stems (SS) in terms of native hip geometry reproducibility, analyzing centrum-collum-diaphyseal angle (CCD) and femoral offset (FO). These parameters allow the SS to be adapted to patient’s anatomy in order to ensure better functional outcomes in total hip arthroplasty (THA). Methods A total of 387 cases of SS met the inclusion criteria. CCD and FO were measured using MediCAD® software Version 6 in preoperative (preop-) and postoperative (postop-) X-rays at 6–12 months after surgery. Considering preop-CCD, the sample was divided into three groups: ≤ 124.9° (A); 125°–129.9° (B); and ≥ 130°(C). Preop- and postop-CCD and FO and the respective average difference (Δ) were examined considering the SS individually and within groups, to verify reproducibility of these parameters. Results The SS considered were eight: Fitmore Zimmer, Pulchra Adler, TRIS Adler, Trifit Corin, Trilock Depuy, Actis Depuy, Profemur Microport, and SMF Smith&Nephew. Groups A, B, and C consisted, respectively, of 113, 124, and 150 cases. Considering all cases, there was a statistically significant ( p  < 0.05) increase in CCD and FO with surgery. Overall, Trifit and Trilock stems were the best in reproducing preop-CCD, Trifit itself followed by Pulchra and Profemur for preop-FO. In groups A and C, the reproduction of preop-CCD was better than preop-FO, in contrast in group B. With regard to preop-CCD reproduction, in group A Trifit and Pulchra, in group B Fitmore and Trifit, and in group C Fitmore and Pulchra were the best. Fitmore in group A, SMF in group B, Pulchra and Trilock in group C were the worst in reproducing preop-FO. Conclusion Each hip anatomy is unique, and reproduction of preop-CCD and preop-FO can be achieved with different SS characteristics. Accurate knowledge of the stems and performing correct preop- planning are crucial to allow the best restoration of the patient's native hip geometry in THA.