Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty

Abstract

BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem. Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal anchoring without diaphyseal invasion, they might demonstrate different subsidence patterns than with the conventional stems. AIM To analyze the factors associated with significant subsidence in short stems, including any radiographic parameters. METHODS The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed. Subsidence, neck-filling ratio (NFR), seating height and lateral stem contact were evaluated after a minimum of two years follow-up. A threshold of subsidence > 3 mm was considered a clinically significant migration. RESULTS For the entire cohort, subsidence occurred in 75 cases (27.4%) with the mean stem subsidence of 0.5 mm. (0-12.7, 1.68). Twelve hips (4.4%) had significant subsidence (> 3 mm). The univariate regression analysis demonstrated that age, diagnosis, BMI, Dorr's type B, NFR, and seating height had no significant influence on significant subsidence, whereas insufficient lateral stem contact (> 1 mm) did have a statistically significant influence [Odds ratio (OR) = 5.02; 95%CI: 1.3-18.9; P = 0.017]. The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor (OR = 5.5; 95%CI: 1.4-21.4; P = 0.014). There was no femoral stem revision for aseptic loosening in our cohort. CONCLUSION This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.