Cementless short-stem total hip arthroplasty in the elderly patient - is it a safe option?: a prospective multicentre observational study.

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License: CC BY 4.0
Serval ID
serval:BIB_1478E89A8488
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cementless short-stem total hip arthroplasty in the elderly patient - is it a safe option?: a prospective multicentre observational study.
Journal
BMC geriatrics
Author(s)
Gkagkalis G., Goetti P., Mai S., Meinecke I., Helmy N., Bosson D., Kutzner K.P.
ISSN
1471-2318 (Electronic)
ISSN-L
1471-2318
Publication state
Published
Issued date
17/04/2019
Peer-reviewed
Oui
Volume
19
Number
1
Pages
112
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young (< 60 years) and a geriatric (> 75 years) population.
Data were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision.
No differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively.
Advanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B.
German Clinical Trials Register; DRKS00012634 , 07.07.2017 (retrospectively registered).
Keywords
Adult, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip/instrumentation, Arthroplasty, Replacement, Hip/methods, Arthroplasty, Replacement, Hip/trends, Bone Cements, Female, Femur/diagnostic imaging, Femur/surgery, Hip Prosthesis/trends, Humans, Male, Middle Aged, Pain Measurement/methods, Pain Measurement/trends, Prospective Studies, Prosthesis Design/instrumentation, Prosthesis Design/methods, Prosthesis Design/trends, Retrospective Studies, Age, Elderly, Optimys, Short stem, Total hip arthroplasty, Young
Pubmed
Web of science
Open Access
Yes
Create date
05/05/2019 16:02
Last modification date
24/01/2020 7:19
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