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Comparative Study
. 2025 May 17;20(1):479.
doi: 10.1186/s13018-025-05889-8.

Long-term clinical comparison of three different femoral stems in Total Hip Arthroplasty with femoral shortening in patients with high-riding hips

Kutalmis Albayrak  1 , Yakup Alpay  2 , Ozgur Ismail Turk  3 , Muhammed Mert  2 , Deniz Akbulut  2 , Akif Albayrak  2
Affiliations
Comparative Study

Long-term clinical comparison of three different femoral stems in Total Hip Arthroplasty with femoral shortening in patients with high-riding hips

Kutalmis Albayrak et al. J Orthop Surg Res. .

Abstract

Background: Developmental hip dysplasia is a common cause of hip arthrosis in young adults, necessitating total hip arthroplasty (THA) for improved function and pain relief. In cases of high-riding hips, transverse femoral shortening osteotomy is often required to facilitate reduction and prevent neurovascular complications. However, the choice of femoral stem in such cases remains controversial due to variations in design and osteoconductive properties. This study aimed to compare the clinical and radiological outcomes of three different femoral stems used in THA with transverse femoral shortening osteotomy.

Methods: A retrospective cohort study was conducted on 107 patients who underwent THA with transverse femoral shortening osteotomy between 2004 and 2014. Patients were divided into three groups based on the femoral stem used: Group 1 (Summit Tapered Stem (Depuy®) (n = 39), Group 2 (SL-PLUS Rectangular Stem (Smith & Nephew®) (n = 31), and Group 3 (Wagner Cone Prosthesis (Zimmer®) (n = 37). Clinical outcomes were assessed using the Harris Hip Score (HHS), and radiological evaluations included osteointegration and union rates. One-way ANOVA was used to compare continuous variables among groups, and post-hoc Tukey's HSD test was applied for pairwise comparisons. Kaplan-Meier survival analysis was performed to evaluate implant survivorship.

Results: The mean preoperative HHS significantly improved from 42.7 ± 6.7 to 84.6 ± 11.5 postoperatively (p < 0.001). Group 3 had significantly higher final HHS compared to Group 1 (p = 0.0002), while no significant differences were observed between Group 1 and Group 2 (p = 0.1947) or Group 2 and Group 3 (p = 0.0723). The overall 10-year survival rate was 87.8%, with Group 3 demonstrating the highest survivorship (91%) and Group 2 the lowest (83%). Intraoperative femoral fissure or fracture rates were significantly higher in Group 1 compared to Group 3 (p = 0.0006), and with a significantly increased need for additional plating in Group 1 (p = 0.0031).

Conclusions: This study suggests that cylindrical fully porous-coated femoral stems (Wagner Cone Prosthesis) provide better clinical outcomes, fewer intraoperative complications, and higher long-term survival rates compared to tapered and rectangular stems in THA with femoral shortening osteotomy. These findings highlight the importance of implant selection in optimizing patient outcomes.

Clinical trial number: Not applicable.

Keywords: Developmental hip dysplasia; Femoral shortening osteotomy; Femoral stem design; Harris hip score; Prosthesis survivorship; Total hip arthroplasty.

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Conflict of interest statement

Declarations. Consent for publication: Written informed consent was obtained from all patients. Ethical approval: University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital institutional review board approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Competing interests: The authors declare no competing interests. Conflict of interest: Kutalmis Albayrak, Yakup Alpay, Ozgur Ismail Turk, Deniz Akbulut, Muhammed Mert and Akif Albayrak declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Comparison of Preoperative and Postoperative Harris Hip Scores (HHS) Among Groups
Fig. 3
Fig. 3
Preoperative and Follow-up Anteroposterior Pelvic Radiographs of a Patient with a Proximal Porous-Coated Tapered Stem
Fig. 4
Fig. 4
Preoperative and Follow-up Anteroposterior Pelvic Radiographs of a Patient Treated with a Rectangular Femoral Stem
Fig. 5
Fig. 5
Preoperative and Follow-up Anteroposterior Pelvic Radiographs of a Patient Treated with a Wagner Cone Cylindrical Femoral Stem
Fig. 6
Fig. 6
Kaplan-Meier Survival Analysis of Femoral Stems Over a 10-Year Follow-Up Period
Fig. 7
Fig. 7
Kaplan-Meier survival curve showing 10-year stem-related survivorship across three femoral stem groups
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