Porous Femoral Fixation in Total Hip Arthroplasty with Short Anatomical Stem: Radiographic Evaluation

BACKGROUND Hip prostheses with short anatomical stems were designed for metaphyseal fixation and to spare bone stock. We present a study of a short anatomical femoral stem used in all age groups of patients with Dorr A and B type of femora. METHODS We reviewed radiographs of 85 hips in 74 patients who had a cementless total hip arthroplasty with a short anatomical 80 mm femoral stem designed to achieve pure metaphyseal fixation. A ream-only technique was used for femoral canal preparation in all patients. At each follow-up, radiological evaluation was performed for stem alignment, proximal metaphyseal fill, subsidence, status of biological fixation of the femoral stem, heterotrophic ossification, radiolucency, osteolysis, and limb length discrepancy of the stem. Acetabular components were evaluated for positioning, acetabular bone coverage, and radiolucent and osteolytic lesions. RESULTS The final mean alignment of femoral stem was 2° valgus. The average intramedullary fill by the stem at the proximal level of the lesser trochanter was 93% in the coronal plane and 88% in the sagittal plane. No components were considered to be undersized. Thirteen hips (15.2%) presented radiolucent lines (10 hips < 1 mm in width and 3 hips [3.5%] 2 mm in width) and 100% of them were not progressive with respect to the last follow-up radiograph. All of the stems had excellent fixation by demonstrating bone ingrowth at the latest follow-up. At the last follow-up, heterotopic ossification was noted in 5 hips. The mean preoperative limb length discrepancy was 9.3 mm and the mean postoperative discrepancy was 3.8 mm. The mean acetabular component angle of the 85 components was 41.2° with a mean anteversion of 22.1°. At the last follow-up, there were no revisions of the femoral component. One patient, 25 months after the index operation, required an acetabular component revision because of recurrent hip dislocation. There were no radiological signs of loosening in any of the short-stem prostheses at the last examination. CONCLUSIONS The short, metaphyseal-fitting anatomic cementless femoral stem provided stable fixation without relying on diaphyseal fixation.