CORR Insights®: No Clinically Important Differences in Thigh Pain or Bone Loss Between Short Stems and Conventional-length Stems in THA: A Randomized Clinical Trial
Abstract
The study by Won et al. [9] addresses a concerning complication after THA, namely thigh pain in conjunction with a cementless femoral stem. In their prospective, randomized study, 100 patients were randomized to receive either a short-length or standardlength, titanium, flat, tapered stem from the same manufacturer (Zimmer Biomet, Warsaw, IN, USA). Thigh pain was evaluated with a 10-point VAS scale, and bone mineral density was assessed with dual-energy x-ray absorptiometry (DEXA) scans. At a minimum of 5 years of follow-up, the authors could detect no difference in thigh pain, Harris hip scores, or loosening between the two groups, while the DEXA scans showed a slightly smaller decrease in bone density in Gruen Zones 2, 3, and 5 in the shorterstem group. Thigh pain after THA can result in impairment and patient dissatisfaction. The incidence and etiology of stem-related thigh pain has remained somewhat elusive over a generation, and while many researchers have implicated design features such as stem material [2, 7], stem size [8], stem shape [6], and extent of porous coating [5], I’m not aware of any high-quality studies that have answered these questions. It seems that the challenges of stem fixation and durability have been solved, with published high survivorship rates across many stem designs. Despite excellent survivorship, manufacturers continue to develop new designs to address the practical challenges that surgeons face. Over time, stems have gradually become…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 100 participants or records.
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