Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis
Abstract Background Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a di...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Arthroplasty |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42836-023-00228-w |
| _version_ | 1797355994841350144 |
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| author | Rajpreet Sahemey Ali Ridha Alastair Stephens Muhamed M. Farhan-Alanie Jakub Kozdryk Bryan Riemer Pedro Foguet |
| author_facet | Rajpreet Sahemey Ali Ridha Alastair Stephens Muhamed M. Farhan-Alanie Jakub Kozdryk Bryan Riemer Pedro Foguet |
| author_sort | Rajpreet Sahemey |
| collection | DOAJ |
| description | Abstract Background Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a difference in outcomes with using a long versus primary or short femoral stem in revision. Methods We performed a systematic review and meta-analysis of all articles comparing long and primary stem length in rTHA for Paprosky 1-3B femoral defects. The primary outcome measure was the reoperation rate after rTHA. Secondary outcomes included infection and dislocation rates, periprosthetic fracture, loosening, mortality, and patient-reported outcome measures (PROMs). Results The results of 3,102 rTHAs performed in 2,982 patients were reported from 9 eligible studies in the systematic review, of which 6 were included in the meta-analysis. The mean patient age was 67.4 and the mean follow-up lasted 5 years (range, 1–15 years). There was no significant difference in the reoperation rate (odds ratio 0.78; 95% confidence interval, 0.28–2.17, P = 0.63). Similarly, there was no significant difference in dislocation or periprosthetic fracture risk. Harris Hip Score was better with primary stems by a mean difference of 14.4 points (P < 0.05). Pooled 5-year stem-related survival was 91.3% ± 3.5% (SD) for primary stems and 89.9% ± 6.7% (SD) for long stems. Conclusions A primary stem provided non-inferior outcomes compared with long stems in rTHA with Paprosky type 1-3B femoral defects. Primary stems may yield a more straightforward technique and preserve distal bone stock for future revision particularly in younger patients. In older patients with lower functional demands and who would benefit from a decreased risk of complications, a long cemented stem is recommended. |
| first_indexed | 2024-03-08T14:19:18Z |
| format | Article |
| id | doaj.art-8fbd633a360447c580f39dafb7d44753 |
| institution | Directory Open Access Journal |
| issn | 2524-7948 |
| language | English |
| last_indexed | 2024-03-08T14:19:18Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthroplasty |
| spelling | doaj.art-8fbd633a360447c580f39dafb7d447532024-01-14T12:12:04ZengBMCArthroplasty2524-79482024-01-016111010.1186/s42836-023-00228-wDoes size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysisRajpreet Sahemey0Ali Ridha1Alastair Stephens2Muhamed M. Farhan-Alanie3Jakub Kozdryk4Bryan Riemer5Pedro Foguet6Department of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireDepartment of Trauma & Orthopaedics, University Hospitals Coventry & WarwickshireAbstract Background Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a difference in outcomes with using a long versus primary or short femoral stem in revision. Methods We performed a systematic review and meta-analysis of all articles comparing long and primary stem length in rTHA for Paprosky 1-3B femoral defects. The primary outcome measure was the reoperation rate after rTHA. Secondary outcomes included infection and dislocation rates, periprosthetic fracture, loosening, mortality, and patient-reported outcome measures (PROMs). Results The results of 3,102 rTHAs performed in 2,982 patients were reported from 9 eligible studies in the systematic review, of which 6 were included in the meta-analysis. The mean patient age was 67.4 and the mean follow-up lasted 5 years (range, 1–15 years). There was no significant difference in the reoperation rate (odds ratio 0.78; 95% confidence interval, 0.28–2.17, P = 0.63). Similarly, there was no significant difference in dislocation or periprosthetic fracture risk. Harris Hip Score was better with primary stems by a mean difference of 14.4 points (P < 0.05). Pooled 5-year stem-related survival was 91.3% ± 3.5% (SD) for primary stems and 89.9% ± 6.7% (SD) for long stems. Conclusions A primary stem provided non-inferior outcomes compared with long stems in rTHA with Paprosky type 1-3B femoral defects. Primary stems may yield a more straightforward technique and preserve distal bone stock for future revision particularly in younger patients. In older patients with lower functional demands and who would benefit from a decreased risk of complications, a long cemented stem is recommended.https://doi.org/10.1186/s42836-023-00228-wArthroplastyFemurHipOutcomeRevisionMeta-analysis |
| spellingShingle | Rajpreet Sahemey Ali Ridha Alastair Stephens Muhamed M. Farhan-Alanie Jakub Kozdryk Bryan Riemer Pedro Foguet Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis Arthroplasty Arthroplasty Femur Hip Outcome Revision Meta-analysis |
| title | Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis |
| title_full | Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis |
| title_fullStr | Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis |
| title_full_unstemmed | Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis |
| title_short | Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis |
| title_sort | does size matter outcomes following revision total hip arthroplasty with long or primary stems a systematic review and meta analysis |
| topic | Arthroplasty Femur Hip Outcome Revision Meta-analysis |
| url | https://doi.org/10.1186/s42836-023-00228-w |
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