Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases

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In recent years a variety of short-stems have been introduced. Stable osteointegration is a key factor for a satisfactory long-term result. The purpose of this study was to evaluate postoperative radiological alterations and subsidence, as a result of using a newly developed device, over a 2-year follow-up.


216 short-stems were implanted in combination with a cementless cup. Patients were allowed full weight-bearing on the first day postoperatively. Pre- and postoperative x-rays were done using a standardised technique. Radiological alterations, such as bone resorption, radiolucency, osteolysis and cortical hypertrophy were detected and located using modified Gruen zones, and subsidence was measured via a conventional digital technique over a 2-year follow-up. In addition, Harris Hip Score (HHS), rest pain and load pain on the visual analogue scale (VAS) were assessed respectively.


At 2-year follow-up 6 stems (2.9%) showed nonprogressive radiolucent lines with a maximum width of 2 mm. Resorption of femoral bone stock was detected in a total of 8 cases (3.9%). Femoral cortical hypertrophy was seen in a total of 9 hips (4.4%). No patient showed osteolysis. A measureable subsidence of at least 2 mm was observed in a total of 15.7% (32 cases) after 6 weeks, corresponding to an initial settlement given full weight-bearing ambulation. Only 1.1% (2 cases) showed further progression at the 6-month follow-up, whereas at the 1- and 2-year follow-ups no further subsidence was observed. After 2 years HHS was 98.1 (65.0–100.0), rest pain on the VAS was 0.2 (0.0–7.0) while load pain was 0.4 (0.0–7.0).


The results of this radiographic analysis give support to the principle of using metaphyseal anchoring, calcar guided short-stems. The low incidence of bony alterations after a follow-up of 2 years indicates a physiological load distribution. After mild initial subsidence a stable osteointegration can be achieved over time.

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