USE OF SHORT FEMORAL COMPONENTS IN TOTAL HIP REPLACEMENT

Aladyshev N.A., Ezhov I.Yu. 

Volga District Medical Centre under Federal Medical and Biological Agency, Nizhny Novgorod, Russia

 USE OF SHORT FEMORAL COMPONENTS IN TOTAL HIP REPLACEMENT 

Total hip arthroplasty is the most demanded operation in orthopedics during many years. Despite good long-term results, the implantation and surgical technique improve continuously, blood loss and the surgery time reduce, and surgical approach is minimized.
Objective – to analyze the evolution of the design of the femoral components, to study the results, advantages and disadvantages of short stems in comparison with the standard ones.
Materials and methods. According to the literature, all available studies on the use of short femoral components have been analyzed.
Results. Some researchers consider that retaining the greater part of the femoral neck will improve the osteointegration process, others reveal a high percentage of migration of these components and poor long-term results.
Conclusion. There are several types of short stems, which are categorized on the basis of the level of resection of the femoral neck. Different types of short stems have very different long-term results. Survival and the level of complications of short stems are comparable with standards. Short stems are used in younger patients. When installing short femoral stems, the front minimally invasive approach is often used.

Key words: short stem; short femoral component; total hip arthroplasty

THE HISTORY OF DEVELOPMENT OF SHORT STEMS ANDTHEIR EVOLUTION AND CLASSIFICATION

Hip replacement is the most successful technique for treating its degenerative and posttraumatic changes, femoral neck fractures and consequences of pelvic fractures (polytrauma), but the increasing number of revision interventions results in searching the new solutions for this problem [1].
The principle of bone preserving is important for hip replacement. It is not a coincidence that the first implants corresponded to this principle.  The first attempts of development of hip implants with short stems were initiated in 1930-1940s. In 1938, Wiles carried out the surgery with placement of the implants for six patients.  The implant construct was associated, and the short femoral component penetrated the femoral neck and was connected to the plate, which was fixed externally with two screws in the subtrochanteric region. One of the first implants by Judet brothers had a short neck stem [2]. In 1956, a Brazilian orthopedist Joao de Azevedo Lage developed the bipolar prosthesis with the short femoral component. [3]. Huggler et al offered the implant, which was similar with the implant by P. Whiles (1938), with the supporting plate. The distinctive feature was the threaded construct of the acetabular component [4].
In the end of 70s and early 80s of 20th century, two stems were developed that influenced on further improvement in this field. In 1979, Pipino et al offered the monoblock (with the head) Biodynamic (Stryker) for cementless fixation. The design features of the stem supposed the preservation of the neck during resection of the proximal femoral bone, with the metal “collar” resting on the preserved neck. In 1982, B.F. Morrey developed Mayo Clinic Stem (Zimmer), with the length of 60 mm, two trapezoidal sections in different planes, titanium mesh coating in the proximal part and the module head [5].
However the rapid development and increasing popularity of the short stems were in the end of 20th and the beginning of 21st century. Currently, there is not any classification of the short femoral components with clear and generally accepted definition of characteristics of implants and degrees of preservation of femoral metaphysis and diaphysis. Therefore, sometimes it is unclear, which femoral stem can be classified as usual or short [5].
Feyen and Shimmin offered the classification of all femoral components on the basis of femoral resection level and the principle of the component fixation: the type 1 – resurfacing, the type 2 – median resection of the head, the type 5 – the stems with distal diaphyseal fixation. At the same time, the differences between the type 3 (the short stem) and the type 4 (the standard stem) on the basis of length measuring are not the benchmarks. However the length of the short stem is characterized by the authors as follows: “the general length of the implant should be less than the double distance between the apex of the greater trochanter and the bottom of the lesser trochanter” [6].
Despite of the variety of the constructs and the names of the short stems, the Joint Implant Surgery and Research Foundation (JISRF) developed the own classification, which similar with the above-mentioned one [7].
McTighe et al. (2013) presented the own simplified classification of the short femoral stems. The classification includes three main types: the type of metaphyseal fixation (standard resection of the neck), the type of neck fixation (high resection of the neck) and the type of fixation in the femoral head (resurfacing) [9].
In his review “Current concepts, classification, and results in short stem hip arthroplasty”, professor Francesco Falez summarized the results of the research of the different classifications and divided them into the following ones: femoral neck – Spiron (k-implant); with neck preservation, such as CFP (Waldemar Link) or Collo-Mis; with preservation of trochanter, such as Aida (Implantcast); the stems which damage the trochanter, such as CLS Brevius Stem (Zimmer) [5].

Results of hip replacement with shortfemoral stems

The short femoral components are used not so long time. Therefore, not all implants can be estimated according to the 10-year survival (the standard index in joint replacement). The requirement for estimation of a standard parameter appeared as result of the variety of the examined group and duration of observation. National Institute of Clinical Excellence (NICE) developed the criterion for estimation of the short stems (because of short period of observation): the number of revision procedure per 100 implants per year. Moreover, 10-year survival shows 90 % correspondence with the annual number of revision procedures – 1 per 100 installed implants [5].
The literature data shows the worst clinical outcomes with higher rate of revision in the conservative (organ-saving) group of the short stems (Collum type, subcapital resection, neck stems). This type includes Gothenburg Osseointegrated Titanium (GOT, Sweden), CUT (Eska, Luebeck, Germany), Spiron (K-Implant, Garbsen, Germany).
    The NICE unified criterion shows two revisions per 100 implants per year for Gothenburg Osseointegrated Titanium (GOT). These findings are described in the group of 40 patients with 24 months of the follow-up. The study of CUT stem (Eska, Luebeck, Germany) showed the satisfactory level of survival. NICE unified estimation showed 1 revision per 100 implants per year [5].
Ender et al. (2007) estimated the results of 123 procedures of hip replacement with Eska short stems in 113 patients. The mean time of observation was 5 years. Revision surgery was conducted in 13 cases. The authors concluded that the mid-term results were unsatisfactory due to high level of aseptic loosening of the femoral component. GOT and CUT stems are not produced anymore [8].
The most famous member of this group (with available studies) is Spiron implant (K-implant, Garbsen, Germany). According to the NICE criterion, the survival of such implants is 0.64 [9]. Lugeder A. et al. (2013) analyzed 28 operations using such implant. Only one case required for the revision surgery owing to aseptic loosening. The functional results increased from 55 to 99 points according to Harris Hip Score (HHS) [10]. Birkenhauer B. et al. (2004) analyzed 38 surgeries. One year later, they noted the excellent results (according to HHS) in 20 patients, without a single case of loosening [5].
Despite the fact that some authors describe the successful use of femoral neck stems, the long term clinical results are usually unsatisfactory due to several causes. The first possible cause is stem valgization with decreasing lateral femoral offset. The signs of resorption around the femoral component have been described, as well as bone atrophy in the calcaneal region in the X-ray images, and development of stress shielding syndrome with 50 % revision rate after 8 years. Another possible cause consists in the implantation technique – the risk of an intrasurgical fracture or malposition of the implant (with potential harm for future stability and integration of the component). This cause is also associated with the limitations in the indications: besides age recommendations, patients with some anatomic features of the femoral neck or unsatisfactory quality of bone tissue are excluded. Despite the decreasing rate of use of such implants, the follow-up can identify the biomechanical features of the femoral neck [11].
The partial collum are CFP, Collo-Mis, Nanos, Mini-Hip, Metha, Optimus, LPI Prime. The stems with greater trochanter preservation are Taperloc, Microplasty, GTS, Fitmore B, Aida. The literature includes some individual reports on MiniHip (Corin, Cirencester, United Kingdom), Optimys (Mathys, Bettlach, Switzerland), Collo-Mis (Lima, Udine, Italy) and Aida (Implantcast, Buxtehude, Germany), but these studies are short term, and the observed groups are small [12, 13, 14].
After comparing Partial Collum (partial neck stems) and Trochanter-Sparing (stems with preservation of the greater trochanter), the absence of any differences in survival was evident. Both types show the revision level less than 1 per 100 implants (NICE criterion) [5].
As mentioned, Mayo Stem (Zimmer) was developed in 1982. According to multiple studies, it has shown the good mid-term results during the years of using. In 1989, B.F. Morrey published the short term results (at least y year) of use of this stem: 95 % of the cases were satisfactory results [9].
In 2000, Morrey B.F. et al. conducted the analysis of 159 stems for the period of 6.1 years: the survival rate was 91 %, 15 revision procedures were conducted, including 9 cases caused by aseptic loosening of the implant components [5]. Gagala et al. (2009) and Goebel D. et al. (2009) received the satisfactory mid-term results [5]. Martins LG (2014) researched the survival of Mayo stem and found the rate of 92.3 % after 6.1 years [16]. Falez et al. (2008) analyzed the results of 160 operations with Mayo stem. The survival rate was 98 % after 4.7 years, with 4 cases of revision surgery [5].
Some authors are unsatisfied with this femoral component. Gilbert et al. (2009) performed 49 operations. The mean observation lasted for 34 months. The authors noted the incorrect placement of the femoral component of the implant in 18 % of the cases, the intrasurgical fracture of the femoral bone – in 4 %. The researchers concluded the infeasibility of this stem due to high risk of the femoral bone fracture [17].
Nanos stem (Smith and Nephew) is also related to this group. Ettinger et al. (2011) described the mid-term results in 72 patients. The mean follow-up was 5.2 years. The survival rate was 100 %. The revision surgery was not required in the study group [18].
Kaipel M. et al. (2015) researched the X-ray features in the group of 49 patients 2 years after hip replacement with Nanos stem. 10 % of the patients showed the radiologic signs of vertical migration that was the predictor of late aseptic loosening [19].
Budde S. et al. (2016) researched the migration of Nanos femoral stem during 2 years after the surgery. The authors concluded that this stem had the migration risk within 3 months after surgery, but then the process did not progress owing to the secondary implant stabilizing [20].
Stadler N. et al. (2016) received the excellent outcomes after use of Nanos femoral component. 81 patients were examined after 2.2 years on average. The functional status improved from 36.6 to 94.5 points according to Harris Hip Score. No revision surgery was performed [21].
Another representative of the short femoral components is Metha (B.Braun). It has been used since 2000. Gulow et al. (2007) firstly described the short term results in young patients. The further studies also showed the good functional results and the high short term survival (Milecki M et al., 2008) [5].
Floerkemeier T. et al. (2012) described the good functional results (HHS increased from 41 to 90 points) in the group of 64 patients (73 hip joints) with aseptic femoral head necrosis. The follow-up was 34 months. The complications were only in 3 cases [22].
Wittenberg et al. investigated the documents from 250 patients who had received hip replacement with Metha stem. The mean follow-up was 4.9 years. The mean age of the patients was 60 years. The mean HHS was 97 points at the moment of the examination. Only 1 % of the operated patients estimated the surgery outcomes as unsatisfactory. The authors described 18 revision surgeries including 9 cases with damage of the module adapter of the implant neck. With exclusion of revisions relation to damages of the module components, the five-year survival was 96.7 % according to Kaplan-Mayer analysis [23].
The results of the biggest study of the Metha femoral components were published by Schnurr et al. in 2017. The study included 1,888 operations for the period of 2004-2014. The mean follow-up was 6 years. The survival rate was 93 %. The revision rate was higher for the module stems with titanium necks (5.3 %) as compared to 1.8 % in the group of the monoblocks [24].
Another short stem by Zimmer is Fitmore. The biomechanical studies showed the relationships between the proximal femoral bone and the implant that influenced on the construct of the femoral stem. Firstly, the size of the intramedullary canal (the stem size) does not correlate with its offset (the neck). Secondly, the offset and the medial curvature of the calcaneal region are associated inversely: the higher radius of the calcaneal curvature, the higher offset. As result, Fitmore includes some various femoral components with different variants of offset distance and the calcaneal curvature (the types A, B, C). The study by Gustke K. (2012) analyzed the results of 500 operations with Fitmore stems 1.3 years after surgery on average. The survival rate was 100 % [25].
Von Roth P et al. (2014) compared the results of Fitmore and CLS stems. The study group included 40 patients. The same amount of the patients was in the control group. The differences in the functional results (HHS, SF-36 and WOMAC) were not identified. The long term results showed the similar survival in both groups [26].
Proxima femoral stem showed the best survival per 100 components per year according to the review of 3 various studies by Van Oldenrijk [8].
Besides the clinical studies, the cadaveric ones present the scientific interest. Westphal et al. (2006) performed the study of the short and standard femoral components placed in the cadaveric femoral bones with subsequent cyclic load (15,000 cycles). It showed the higher level of migration for the short femoral components in comparison with the standard ones. However when contacting with the cortical bone, with good quality of bone tissue and correct positioning, the short femoral components provide more physiologic distribution of the load to the proximal hip, and prevent stress shielding syndrome [27].

ANTERIOR APPROACH TO HIP JOINT

Low invasive approaches to the hip joint became possible with appearance and evolution of the short femoral stems. Now the researchers and the surgeons are giving more attention to the anterior approach to the hip joint. The direct anterior approach to the hip joint was firstly described by Carl Hueter in 1881. The development of this approach is improperly associated with Smith-Petersen, considering the fact that he used it during his researches beginning from 1917 (the first mention in his publication). In the modern literature, the names of both surgeons are associated with development and popularization of this approach. Judet brothers described this approach for hip replacement in 1950. O’Brien described it in 1955. Then the interest to the anterior approach for hip replacement decreased since Sir John Charnley advocated using the approach with greater trochanter osteotomy. After the years, Light and Keggi published the first American experience with the direct anterior approach for 104 patients. The anterior hip approach presents the incision or intermuscular fiber separation through the interval between the TFL Musculus Tensor Fascia Lata and the musculus sartorius. Some authors describe this technique for both primary hip replacement and proximal hip fracture [28].
Some authors think that the anterior approach can be used for patients with specific body tympanum and anatomic features of the hip joint. The “ideal” patient is with moderate muscular mass, with valgus femoral neck and good hip offset, and the body mass index < 30. Some anatomic features impede the anterior approach: wide or horizontal iliac wing limits the approach to the femoral bone canal during creation and placement of the femoral component. The varus position of the neck with decreased neck-diaphysis angle and the femoral offset, as well as obesity and high muscular mass, give deeper position of the hip and impedes the positioning of the components of the implant. The disadvantage of the anterior approach is the limited approach to the posterior column of the pelvis. If a patient has a deficiency of the posterior wall of the pelvis and the defect is planned to be filled with the augment, then the anterior approach is not recommended [29].
Most authors use the supination position on the standard or orthopedic table. On the standard table, the patient should be placed in the manner that the hip joint field would be in the place of pivot connection of the table. Michel et al. offer the lateral position. Kennon et al. practice the inclination of the operation table. Also the pelvis should be elevated with a roller under the sacrum. If the orthopedic table is used, the leg should be fixed appropriately for prevention of the fibular nerve neuropathy [30].
Most authors use the anterior superior iliac spine and the greater trochanter as the landmarks during making the skin incision. The oblique skin incision should begin 2-4 cm lower and more distal than the anterior superior iliac spine, with oblique pathway to the greater trochanter. The incision should not go beyond the intertrochanteric line owing to danger of an injury to the lateral femoral circumflex artery and the femoral nerve. The incision should be in the plane of the line connecting the anterior superior iliac spine and the middle part of the patella. Electron-optical image intensifying is used for searching the femoral neck, which is the relative middle part of the approach [31].
A common complication of such approach is a damage of the lateral cutaneous nerve. Despite the fact that the lateral interval between the musculus tensor fasciae latae and the musculus sartorius is considered as safe from the perspective of topical anatomy of the lateral cutaneous nerve, the cadaveric studies showed that its gluteal branch is located 44 mm from the anterior superior iliac spine; in 50 % of the cases, the femoral branch of the nerve crossed the anterior body of the musculus tensor fasciae latae with the distance of 46 mm from the anterior superior iliac spine [32]. The cadaveric study showed some abnormalities in location of the branches of the lateral cutaneous nerve in 10 % of the cases in the group of 60 persons [33]. De Geest et al. noted the decreasing incidence of injuries to the external skin nerve of the hip in lateralization of this approach. Subcutaneous fat should be dissected in the blunt manner. Then the m. tensor fasciae latae is opened from the medial side of the greater trochanter, leaving some distance for subsequent suturing. Fascial dissection in the lateral interval can cause the injury to the motor branch of the superior gluteal nerve [34].
Fascial dissection towards posterior direction is not recommended. The fascia is rigid and thick there, and it passes into the dorsal gluteal muscle. From other side, in case of medialization, the approach enters the borders of the femoral triangle that significantly increases the risk of the vascular-nervous bundle damage. When capsule dissected, it is recommended to bring the sharp retractor to the region behind the greater trochanter. The second retractor (Hohmann) is to be brought trough m. vastus lateralis to the region behind the medial surface of the femoral neck, with medial shift of m. femoris rectus and m. sartorius. The capsulotomy and capsuloectomy are conducted [35].
The lateral approach to the hip joint is performed in 42 % of cases of hip replacement, but muscular dissection causes the intense postsurgical pain syndrome, long term hospital stay and long term rehabilitation. The anterior approach has the lower length and lower rate of injuries in comparison with the lateral one, i.e. it is classified as low invasive [36].
Bremer et al. (2011) conducted MRI for the hip joint after hip replacement with lateral, posterior and anterior approaches. He did not identify any differences in m. tensor fasciae latae. However some changes in the group of the abductors were found (partial damage, tendinitis, bursitis, fat degeneration) and they were more common for transgluteal approaches [37].
Chen Yue (2015) et al. conducted the metaanalysis of 12 studies of lateral and direct anterior approaches (2,991 and 1,910 operations with direct and lateral approaches correspondingly). The direct anterior approach was associated with early rehabilitation of the patients, lower pain after surgery and decreasing hospital stay [38].
Molli et al. (2013) carried out a big study. They performed 658 operations with hip replacement using low invasive direct anterior approach for 606 patients within the period from March 2006 to March 2008. 389 cases included the standard femoral components, 269 cases – the short femoral components. The mean follow-up was 29.2 months. The authors noted the higher rate of complications after use of the standard length stems (3.1 %) in comparison with the short femoral components (0.4 %). There were not any statistical differences in prosthesis survival and hip functioning (HHS) between the groups [39].
Other researchers claim that the anterior approach has not any advantages. Reichert JC et al. (2015) studied 171 hip replacement operations with direct and lateral approaches. The mid-term observation did not identify any significant differences in the functional status (Harris hip score) and in life quality (SF-36) [40].
Rathod PA et al. (2014) identified the similar functional results in comparison of anterior and posterior approaches, and the relationship between fast rehabilitation and selection of patients [41]. The metaanalysis by Higgins BT et al. included 17 studies (2,302 operations). The authors did not identify any statistical significance in in pain and the functional status after use of anterior and posterior approaches [42].
Engdal M et al. (2016) studied the postsurgical physical activity (with the accelerometer) within 4 days after hip replacement surgery with different approaches (anterior, lateral and posterior). No statistical differences were found between the groups [43].
Alijanipour P. et al. (2016) conducted the comparative study of heterotopic ossification in anterior and lateral approaches. 1,482 patients were examined. The incidence of the initial stages of ossification (according to Brooker) was higher in the group of lateral approaches (36.1 and 19.4 % correspondingly). However intense ossification (the degrees 3 and 4 according to Brooker) developed in both groups with similar incidence (3.9 and 3.0 %) [44].
Despite of the evident advantages of the approach, some disadvantages exist such as acquisition of special tools, surgical training, increasing surgery time and use of the image intensifier. Masonis analyzed 100 operations and concluded that the statistically significant time of surgery decreased only after realization of 100 operations with the anterior approach [34].
Although some authors indicate the low rate of complications after this approach, others describe the high risk. The metaanalysis showed the similar rate of complications except for the femoral cutaneous nerve damage. The incidence of this complication is 5.69 higher for anterior direct approach (De Geest) [34].
Spaans et al. described 20 % level of complications after 46 hip replacement procedures with the anterior approach. The complications included early loosening of the femoral and acetabular components, which required for revision surgery [45].
Gwo-Chin Lee et al. (2015) analyzed the complications of the direct anterior approach. The author carried out the metaanalysis of 38 medical studies including 11,810 hip replacement procedures. The analysis identified 920 complications (7.8 %). The most common complications were femoral nerve neuropathy and the lateral cutaneous femoral nerve damage (2.8 %). The intrasurgical fractures of the femoral bone were quite common (2.3 %). The risk of a fracture was higher for this approach and was associated with limited visualization and the operating surgeon’ experience. The incidence of dislocations was 1.2 % that was comparable with the standard approaches. The incidence of postsurgical wound complications was 1.2 % [46].
Christensen et al. described 1.4 % level of the complications that was significantly higher than for the standard approaches. Hallert et al. described the revision level of 2.5 %, whereas De Geest et al. showed the high incidence of revision operations (6.7 %) within the first 12 months after surgery [47, 48, 34].
The domestic publications for this topic are rare. Karagodina et al. (2015) performed the study of the adaptive changes in the femoral bone around the prosthesis component. The authors compared the bone mineral density in two groups. The short femoral component Fitmore was implanted for 26 patients, the standard femoral component Alloclassic – for 20. 3 months after hip replacement, they observed the loss of bone mineral density around the implants of both types, with higher intensity in Gruen’s regions 2 and 7 for Fitmore stem and in the regions 6 and 7 for Alloclassic implant. 6 months after surgery, almost all regions of the femoral bone showed the moderate stabilization around the implants. 12 months after hip replacement, regardless of the type and design of the implants, the loss of bone mass was observed in Gruen’s regions 1 and 7 that did not make the negative influence on the clinical outcome. The authors concluded that regardless of the implant design, the specific rebuilding of bone matter happens in the proximal femoral bone, with lost bone mass in Gruen’s regions 1 and 7 and relative bone condensation in the distal parts of the implant (stress-shielding). It means that the shorter femoral components do not favor the preservation of bone mass in the proximal hip [49].
Firsov et al. (2015) published the study of the functional outcomes of the short femoral components with use of navigation. Hip joint replacement was carried out for 210 patients with hip joint abnormality. The patients were distributed into three groups depending on the type of the femoral components and use of computer navigation.  Harris score and VAS were used for estimating the results. The best results were achieved in the group of the patients with the short femoral component installed under computer navigation. HHS increased from 45.8 points (before surgery) to 80.9 points 6 months later, and 85.4 in the 12th month of observation. The computer navigation system improved the functional results of hip replacement [50].    

CONCLUSION

The popular procedure of hip joint replacement improves all around the world. The surgical technique improves, with the trend to minimizing surgical injury. The low invasive approaches are preferable. The direct anterior approach has been improved during the recent years. Its advantages are preservation of the hip joint stabilizers, low traumatic effect and fast rehabilitation. Other researchers show the disadvantages of this technique: need for special instruments, limitations in body composition, long time of surgery. The issue is poorly described in the domestic literature. The results from different researches are contradictory, and the issue of popularization of the anterior approach is still opened.
The concept of lower traumatic effect of hip replacement has touched upon the approaches for the hip joint and implantation process. The short femoral components appeared in the early 80s of the previous century, and they have been still improved. Their main sign is not the length of the femoral component, but the level of resection of the proximal hip. Some researchers consider that preservation of most part of the femoral neck improves the osteintegration process. The second advantage is preservation of bone tissue for subsequent revision operations that is important for young patients.
The literature findings are contradictory and require for further studies.

Information about conflict of interests:

The study was conducted without sponsorship. The authors declare the absence of any clear and potential conflicts of interests relating to publication of this article.

REFERENCES:

1. Zagorodniy NV. Hip joint replacement. The basics and practice: the manual. M.: GEOTAR-Media, 2013. 699 p. Russian (Загородний Н.В. Эндопротезирование тазобедренного сустава. Основы и практика: руководство. М.: ГЭОТАР-Медиа, 2013. 699 с.)
2. Knight SR, Aujla R, Biswas SP. Total hip arthroplasty - over 100 years of operative history. Orthopedic Reviews. 2011; 3(2): e16
3. McTighe T. The science behind a short curved stem total hip replacement. In Conference: ICJR Australia, February 14-16, 2014. At Sydney Australia Conference Paper; March 2014
4. McElroy MJ, Johnson AJ, Mont MA, Bonutti PM. Short and standard stem prostheses are both viable options for minimally invasive total hip arthroplasty. Bulletin of the NYU Hospital for Joint Diseases. 2011; 69 (Suppl 1): S68-S76
5. Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics. 2015; 38 (3 Suppl): S6-S13
6. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement? Bone Joint J. 2014; 96-B (4): 442-448
7. McTighe T, Keggi J, Stulberg D, Keppler L, Brazil D, McPherson EJ. Total hip stem classification system. Reconstructive Review. 2014; 4(2). URL: https://reconstructivereview.org/ojs/index.php/rr/article/view/70
8. Van Oldenrijk J, Molleman J, Klaver M, Poolmann RW, Haverkamp D. Revision rate after short-stem total hip arthroplasty: a systematic review of 49 clinical studies. Acta Orthop. 2014; 85(3):250-258
9. McTighe T, Stulberg D, Keppler L, Keggi J, Kennon R, Aram T, McPherson Ed. A Classification system for short stem uncemented total hip arthroplasty orthopaedic proceedings. British Editorial Society of Bone & Joint Surgery. 2013; March
10. Lugeder A, Haring E, Muller A, Droste P, Zeichen J. Total hip arthroplasty with the cementless Spiron femoral neck prosthesis [in German]. Oper Orthop Traumatol. 2013; 25(4): 388-397
11. Jerosch J. Differences between short stem prostheses [in German]. Orthopade. 2014; 43(8):783-796
12. Jerosch J. MiniHiP. In: Kurzschaftendoprothesen: Wo liegen die Unterschiede. Jerosch J, ed. Cologne, Germany: Deutscher Arzte-Verlag; 2013. P.164-166
13. Pfeil J, Siebert W, Grieshuber HM. Optimys. In: Kurzschaftendoprothesen: Wo liegen die Unterschiede. Jerosch J, ed. Cologne, Germany: Deutscher Arzte-Verlag; 2013. P.23-40
14. Krieger M. Collo-MIS. In: Kurzschaftendoprothesen: Wo liegen die Unterschiede. Jerosch J, ed. Cologne, Germany: Deutscher Arzte-Verlag; 2013. P. 134-138
15. Mumme T. Aida. In: Kurzschaftendoprothesen: Wo liegen die Unterschiede. Jerosch J, ed. Cologne, Germany: Deutscher Arzte-Verlag; 2013. P. 109-111
16. Martins LG, Garcia FL, Picado CH. Septic loosening rate of the Mayo femoral stem with medium-term follow up. J Arthroplasty. 2014; 29(11): 2122-2126
17. Gilbert RE, Salehi-Bird S, Gallacher PD, Shaylor P. The Mayo conservative hip: experience from a district general hospital. Hip International: The Journal of the Clinical and Experimental Research on Hip Pathology and Therapy. 2009; 19(3): 211-214
18. Ettinger M, Ettinger P, Lerch M, Radtke K, Budde S, Ezechieli M, et al. The Nanos short stem in total hip arthroplasty: a midterm follow-up. Hip Int. 2011; 21(5): 583-586
19. Kaipel M, Grabowiecki P, Sinz K, Farr S, Sinz G. Migration characteristics and early clinical results of the  NANOS® short-stem hip arthroplasty. Wien Klin Wochenschr. 2015; 127(9-10): 375-378
20. Budde S, Seehaus F, Schwarze M, Hurschler C, Floerkemeier T, Windhagen H, et al. Analysis of migration of the Nanos® short-stem hip implant within two years after surgery. Int Orthop. 2016; 40(8): 1607-1614
21. Stadler N, Lehner J, Abbas R, Trieb K. Prospective mid-term results of a consecutive series of a short stem. Acta Orthop Belg. 2016; 82(2): 372-375
22. Floerkemeier T, Tscheuschner N, Calliess T, Ezechieli M, Floerkemeier S, Budde S, Windhagen H, von Lewinski G. Cementless short stem hip arthroplasty METHA® as an encouraging option in adults with osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2012; 132(8): 1125-1131
23. Wittenberg RH, Steffen R, Windhagen H, Bucking P, Wilcke A. Five-year results of a cementless short-hip-stem prosthesis. Orthop Rev (Pavia). 2013; 5(1): e4
24. Schnurr C, Schellen B, Dargel J, Beckmann J, Eysel P, Steffen R. Low Short-Stem Revision Rates: 1-11 year results from 1888 total hip arthroplasties. J Arthroplasty. 2017; 32(2): 487-493
25. Gustke K. Short stems for total hip arthroplasty: initial experience with the Fitmore stem. J Bone Joint Surg Br. 2012; 94 (11 Suppl A): 47-51
26. von Roth P, Perka C, Mayr HO, Preininger B, Ziebula F, Matziolis G et al. Reproducibility of femoral offset following short stem and straight stem total hip arthroplasty. Orthopedics. 2014; 37(7): e 678-684
27. Westphal FM, Bishop N, Honl M, Hille E, Puschel K, Morlock MM. Migration and cyclic motion of a new short-stemmed hip prosthesis – a biomechanical in vitro study. Clin Biomech (Bristol, Avon). 2006; 21(8): 834-840
28. Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014; 22: 595-603
29. Unger AC, Schulz AP, Paech A, Jurgens Ch, Renken FG. Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique. Arch Orthop Trauma Surg. 2013; 133: 1509-1516
30. Moskal JT, Capps SG, Scanelli JA. Anterior muscle sparing approach for total hip arthroplasty. World J Orthop. 2013; 4: 12-18
31. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013; 28: 1634-1638
32. Alexandrov T, Ahlmann ER, Menendez LR. Early clinical and radiographic results of minimally invasive anterior approach hip arthroplasty. Adv Orthop. 2014; 2014: 954208
33. Grob K, Monahan R, Gilbey H, Yap F, Filgueira L, Kuster M. Distal extension of the direct anterior approach to the hip poses risk to neurovascular structures: an anatomical study. J Bone Joint Surg Am. 2015; 97: 126-132
34. De Geest T, Vansintjan P, De Loore G. Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta Orthop Belg. 2013; 79: 166-173
35. Leunig M, Faas M, von Knoch F, Naal FD. Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res. 2013; 471: 2245-2252
36. Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg. 2013; 133:1595-1600
37. Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011; 93(7): 886-889
38. Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: a systematic review and meta-analysis (PRISMA). Medicine (Baltimore). 2015; 94(50): e2126
39. Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin. Orthop. Relat. Res. 2012; 470(2): 450-461
40. Reichert JC, Volkmann MR, Koppmair M, Rackwitz L, Ludemann M, Rudert M, et al. Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty. Int Orthop. 2015; 39: 2309-2313
41. Rathod PA, Orishimo KF, Kremenic IJ, Deshmukh AJ, Rodriguez JA. Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty. J Arthroplasty. 2014; 29(6): 1261-1264
42. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and metaanalysis. J Arthroplasty. 2015; 30: 419-434
43. Engdal M, Foss OA, Taraldsen K, Husby VS, Winther SB. Daily physical activity in total hip arthroplasty patients undergoing different surgical approaches: a cohort study. Am J Phys Med Rehabil. 2016; Dec 2
44. Alijanipour P, Patel RP, Naik TU, Parvizi J. Heterotopic ossification in primary total hip arthroplasty using the direct anterior vs direct lateral approach. J Arthroplasty. 2017; 32(4): 1323-1327
45. Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop. 2012; 83(4): 342
46. Lee GC, Marconi D. Complications Following Direct Anterior Hip Procedures: Costs to Both Patients and Surgeons. J Arthroplasty. 2015; 30(9 Suppl): 98-101
47. Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty. 2014; 29(9): 1839
48. Hallert O, Li Y, Brismar H et al. The direct anterior approach: initial experience of minimally invasive technique for total hip arthroplasty. J Orthop Surg Res. 2012; 7:17
49. Karagodina MP, Shubnyakov II, Tikhilov RM, Pliev DG, Denisov AO. Adaptive bone tissue remodeling around femoral components of cementless fixation Fitmore and Alloclassic. Traumatology and Orthopedics of Russia. 2015; 4: 15-28. Russian (Карагодина М.П., Шубняков И.И., Тихилов Р.М., Плиев Д.Г., Денисов А.О. Адаптивное ремоделирование костной ткани вокруг бедренных компонентов бесцементной фиксации Fitmore и Alloclassic //Травматология и ортопедия России. 2015. № 4. C. 15-28)
50. Firsov SA, Vereshchagin NA, Shevchenko VP. Functional outcomes of hip joint replacement after implantation of short femoral component under navigation control. Fundamental Research Medical Sciences. 2015; 1: 840-844. Russian (Фирсов С.А., Верещагин Н.А., Шевченко В.П., Функциональные исходы эндопротезирования тазобедренного сустава после имплантации короткого бедренного компонента под контролем навигации //Fundamental Research Medical Sciences. 2015. № 1. C. 840-844)

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