Clinical results of a short stem with flat tapered wedge design in primary total hip arthroplasty for hip dysplasia in Asians

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 28; no. 3; p. 2309499020956742
• Main Authors: Hayama, Tetsuo, Otani, Takuya, Fujii, Hideki, Kawaguchi, Yasuhiko, Abe, Toshiomi, Takahashi, Motoi, Saito, Mitsuru
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2020; SAGE Publishing
• Subjects: hip prosthesis implantation; total hip replacement; hip dysplasia
• ISSN: 2309-4990; 1022-5536; 2309-4990
• DOI: 10.1177/2309499020956742

Background: Cementless femoral reconstruction is challenging in hip dysplasia due to deformity of the proximal femur causing insufficient stem fixation and/or inadequate neck anteversion. Strategies to address these problems include the use of a modular stem or a distal fixation stem, but both stems have some characteristic disadvantages. Methods: We studied the postoperative clinical outcomes in primary total hip arthroplasty in 257 hips using the flat tapered wedge short femoral stem for hip dysplasia in an Asian population (postoperative follow-up period: 2 years to 6 years and 11 months; mean 4 years and 5 months). We took advantage of the characteristic of high flexibility in stem placement because of its low volume, positioning it while performing some varus/valgus and rotational alignment adjustments. Results: Favorable clinical functional outcomes were obtained, including the radiographic outcome of biological fixation achieved in all stems. Regarding complications, there was no case of split fracture of the femoral calcar region during stem insertion, and the rate of postoperative dislocation was also low at 0.4% (1 case). In the pre- and postoperative computed tomography measurements, the variability in stem anteversion postoperatively was significantly reduced compared to preoperative anatomical anteversion. Conclusion: This flat-shaped short low-volume stem likely has high flexibility in positioning in cases of hip dysplasia and can be easily positioned to avoid fractures while still achieving secure fixation.