Stem migration and bone density at ten years : a randomized radiostereometry and dual-energy X-ray absorptiometry study on a short uncemented hip stem with and without a collar.

Abstract

Short, uncemented hip stems might provide a favourable alternative in total hip arthroplasty (THA) by preserving proximal bone mass through reduced strain-adaptive remodelling. We evaluated and compared the migration and periprosthetic bone remodelling of a short stem with and without a collar, using radiostereometric analysis (RSA) to measure implant migration and dual-energy X-ray absorptiometry (DXA) to evaluate periprosthetic bone remodelling. In this study we present ten-year follow-up results, completing previously published two- and five-year RSA and DXA studies. A total of 50 patients (34 males) underwent THA due to osteoarthritis and were randomized to either a collared or collarless short stem. Patients were followed for ten years with repeated RSA and DXA examinations. Patient-reported outcome measures (PROMs), Hip disability and Osteoarthritis Outcome Score, EuroQol five-dimension questionnaire, and Forgotten Joint Score were collected. A total of 45 patients remained at the ten-year follow-up. RSA showed early implant stabilization and osseointegration within three months after an initial subsidence of 0.62 mm (95% CI 0.33 to 0.91) for collared and 0.76 mm (95% CI 0.55 to 0.96) for collarless stems. Minimal further migration was observed up to ten years. Net bone mineral density at ten years was -3.3% (95% CI -9.2 to 2.7) and -2% (95% CI -7.3 to 3.4) in collared and collarless stems, respectively. The presence of a collar did not result in any statistically significant differences either for RSA or DXA results. PROMs improved as expected, and remained high up to ten years in both groups. None of the stems was revised. The short stem remains stable at ten years and preserves bone mass, both with and without a collar. These findings support the continued use and further evaluation of this type of short, uncemented stem.