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. 2021 Nov;141(11):1993-2000.
doi: 10.1007/s00402-021-03852-w. Epub 2021 Mar 24.

The impact of reducing the femoral stem length in total hip arthroplasty during gait

Anatole Vilhelm Wiik  1 , Adeel Aqil  2 , Bilal Al-Obaidi  2 , Mads Brevadt  2 , Justin Peter Cobb  2
Affiliations

The impact of reducing the femoral stem length in total hip arthroplasty during gait

Anatole Vilhelm Wiik et al. Arch Orthop Trauma Surg. 2021 Nov.

Abstract

Aim: The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics.

Methods: Patients uniformly with the same brand implant of differing lengths (100 mm vs 140-166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare.

Results: With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem.

Conclusion: By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

Keywords: Biomechanics; Gait; Short stem total hip arthroplasty.

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Conflict of interest statement

Anatole Vilhelm Wiik has no conflicts of interest, Adeel Aqil has no conflicts of interest, Bilal Al-Obaidi has no conflicts of interest, Mads Brevadt has no conflicts of interest, Justin Peter Cobb is the principle investigator on the medicines and healthcare products regulatory agency (MHRA) regulated post market surveillance study on the Furlong Evolution stem.

Figures

Fig. 1
Fig. 1
A postoperative weight bearing plain radiograph demonstrating the difference of femoral stem lengths
Fig. 2
Fig. 2
Ground reaction forces during uphill walking (15% uphill at 4 km per hour). The central line is the mean and the whiskers are the 95% confidence interval (CI) of the controls
Fig. 3
Fig. 3
Mean ground reaction force trends at increasing speeds for the arthroplasty group: weight acceptance (top), push-off (middle), and midstance (bottom)
See this image and copyright information in PMC

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