Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

Abstract

Background: In recent years, there has been an increase in the number of total hip arthroplasty procedures in the younger patient population. This active group has higher expectations of their prosthesis in comparison to the older population, and there is a greater physical demand for the prosthesis. Short femoral stems were introduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population. Currently, the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.

Aim: To determine the 5-year survival of the Optimys hip stem.

Methods: This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands. All patients received the Optimys short stem (Mathys Ltd, Bettlach, Switzerland). The primary outcome measure was survival of the hip stem, with revision as the endpoint. The secondary outcome measurements included patient-reported outcome measures (PROMs). Kaplan-Meier analysis was used to calculate the 5-year survival rate. Log-minus-log transformation was performed to calculate the 95% confidence interval (95%CI). Mixed model analyses were performed to assess the course of the PROMs during the 1^st 2 years after surgery. Analyses were modeled separately for the 1^st and 2^nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.

Results: The mean age of the total 500 patients was 62.3 years (standard deviation: 10.6) and 202 were male (40%). At a median follow-up of 5.5 years (interquartile range: 4.5-6.7), 7 patients were deceased and 6 revisions were registered, for infection (n = 3), subsidence (n = 2) and malposition (n = 1). This resulted in an overall 5-year survival of 98.8% (95%CI: 97.3-99.5). If infection was left out as reason for revision, a stem survival of 99.4% (95%CI: 98.1-99.8) was seen. Baseline questionnaires were completed by 471 patients (94%), 317 patients (63%) completed the 1-year follow-up questionnaires and 233 patients (47%) completed the 2-year follow-up. Both outcome measures significantly improved across all domains in the 1^st year after the operation (P < 0.03 for all domains). In the 2^nd year after surgery, no significant changes were observed in any domain in comparison to the 1-year follow-up.

Conclusion: The Optimys stem has a 5-year survival of 98.8%. Patient-reported outcome measures increased significantly in the 1^st postoperative year with stabilization at the 2-year follow-up.

Keywords: 5-year survival; Femoral stem; Optimys; PROMs; Revision; Short stem; Survival; Total hip arthroplasty.

Figure 1

Optimys short stem (Mathys Ltd. Bettlach, Switzerland).

Figure 2

Kaplan-Meier survival curve illustrating 5-year survival, including all reasons for revision.

Figure 3

Follow-up graph of the Hip Disability and Osteoarthritis Outcomes Score scores from baseline to the 2-yr follow-up (means with 95% confidence interval). HOOS: Hip Disability and Osteoarthritis Outcome Score; ADL: Activities of daily living.