The medullary cavity morphology of the proximal femur influences the fixation pattern of the rectangular tapered short stem in total hip arthroplasty.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1989-

Arthroplasty, Replacement, Hip*/methods ; Arthroplasty, Replacement, Hip*/instrumentation ; Hip Prosthesis* ; Bone Density* ; Prosthesis Design* ; Femur*/surgery; Humans ; Male ; Female ; Middle Aged ; Aged ; Absorptiometry, Photon ; Retrospective Studies ; Adult ; Aged, 80 and over

Introduction: This study aimed to evaluate differences in the pattern of fixation with a rectangular tapered short stem (Fitmore stem) due to proximal femoral medullary cavity morphology based on periprosthetic bone mineral density (BMD) and radiological findings.
Materials and Methods: We analyzed 105 consecutive patients (Dorr type A, 18; Dorr type B, 66; Dorr type C, 21) who underwent total hip arthroplasty using a Fitmore stem. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry from 1 to 24 months postoperatively and radiological analysis was performed. Clinical outcomes were evaluated using the Harris hip score (HHS) and the University of California Los Angeles (UCLA) activity score preoperatively and 24 months postoperatively.
Results: At 24 months postoperatively, Dorr type C had significantly decreased BMD changes in Gruen zones 2, 6, and 7 compared to Dorr types A and B, and conversely, significantly increased BMD changes in zone 4 (p < 0.05). Dorr type C had significantly greater subsidence than the other types (p < 0.01) and significantly higher cortical hypertrophy in zone 3 (p < 0.01). Stress shielding was not significantly different between Dorr types. The preoperative and postoperative HHS and UCLA activity scores showed no significant differences between the Dorr types.
Conclusions: In Dorr type C, BMD significantly decreased in the proximal femur with a rectangular tapered short stem, suggesting that the stem was fixed at the distal part. Careful observation of this prosthesis over time is needed in patients with Dorr type C.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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Keywords: Bone mineral density; Cortical hypertrophy; Dorr classification; Rectangular tapered short stem; Total hip arthroplasty

Date Created: 20240828 Date Completed: 20240922 Latest Revision: 20240922

20240923

10.1007/s00402-024-05500-5

39198309