Medium-term outcomes of conventional versus short uncemented femoral stems for primary total hip arthroplasty in patients younger than 55 years

Abstract

Background: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up. Methods: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively ( p  = 0.11). The mean age of the series was 46 years (17–55) ( p =0.16). The mean follow-up of groups A and B were 9.9 (7–12) years and 9.7 (7–12) years, respectively ( p =0.21). Results: Mean Harris Hip Score improved from 55 to 92 in group A ( p <0.001) and from 54 to 95 in group B ( p <0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0–28) mm and 26 (11–38) mm, respectively ( p =0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively ( p =0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p =0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p =0.06). Conclusions: Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.