ArticleInternational orthopaedics2021
Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation.
Article in International orthopaedics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07600632 (Clinical and Radiographic Evaluation of a Short Stem for Primary Hip Replacement Performed by Anterior Approach), which is not on this map. Cited by 7 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Clinical and Radiographic Evaluation of a Short Stem for Primary Hip Replacement Performed by Anterior Approach: A Retrospective and Prospective Study
Who cites it
7 citing papers in PubMed, 15 citations in OpenAlex.
- Is direct anterior approach associated with a compromise of femoral stem survival after total hip arthroplasty? A regional registry-based analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Performance of Cementless Hip Arthroplasty Stem Types Based on Consolidated Large Registry Data.Arthroplasty today · 2025Article
- No differences in clinical and radiographic outcomes between standard offset and high offset short cementless stems.Archives of orthopaedic and trauma surgery · 2024Article
- Cementless short stem total hip arthroplasty in patients older than 75 years: is it feasible?Archives of orthopaedic and trauma surgery · 2024Article
- Radiographic signs and hip pain 5 years after THA with a cemented stem predict future revision for aseptic loosening: a prospective cohort study.Acta orthopaedica · 2024Article
- 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis.Journal of clinical medicine · 2022Article
- Comment on an article by Guido Garavaglia et al.: Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation.International orthopaedics · 2021Article
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Authors and funding
7 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeShort stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation.
methodsBetween April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2-9.73 years).
resultsDuring the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2-7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between - 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1.
conclusionPatients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.
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