Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages.
Purposes
The objectives of this study were to review: (1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems.
Methods
A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct.
Results
Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known.
Conclusions
Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate on-going bone remodelling and assess implant performance and survival.
No Authors listed. National Joint Registry for England and Wales: 8th annual report 2011
2.
AlbaneseCVSantoriFSPavanLLearmonthIDPassarielloRPeriprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stemsActa Orthop200980291–710.3109/17453670903074467
3.
Bichmann P, Horst F. First experiences with the Metha modular short stem prosthesis. South-German Orthopaedic Congress 2006; Baden-Baden; Presentation 233
4.
BiggiFFranchinFLovatoRPipinoFDEXA evaluation of total hip arthroplasty with neck-preserving technique: 4 year follow-upJ Orthopaed Traumatol20045156–15910.1007/s10195-004-0063-4
5.
BraudPFreemanMARThe effect of retention of the femoral neck and of cement upon the stability of a proximal femoral prosthesisJ Arthroplasty19905SupplS5–1010.1016/S0883-5403(08)80018-6
6.
BriemDSchneiderMBognerNBothaNGebauerMGehrkeTSchwantesBMid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesisInternational Orthopaedics201135655–66010.1007/s00264-010-1020-x
7.
BollandBJCullifordDJLangtonDJMillingtonJPArdenNKLathamJMHigh failure rates with a large-diameter hybrid metal-on-metal total hip replaeement: clinical, radiological and retrieval analysisJ Bone Joint Surg Br2011935608–1510.1302/0301-620X.93B5.26309
8.
BuergiMLStoffelKKJacobHACBereiterHHRadiological Findings and clinical results of 102 thrust-plate femoral hip prostheses. a follow-up of 2 to 8 yearsJ Arthroplasty2005201108–11710.1016/j.arth.2004.09.042
9.
CarlsonLAlbrektssonFreemanMARFemoral neck retention in hip arthroplasty. A cadaver study of mechanical effectsActa Orthop Scand19885916–910.3109/17453678809149333
10.
CristofoliniLJuszczykMTaddeiFFieldRERushtonNVicecontiMAssessment of femoral neck fracture risk for a novel proximal epiphyseal hip prosthesisClin Biomech (Bristol, Avon)2011266585–9110.1016/j.clinbiomech.2011.01.009
11.
DonnellyWJKobayashiAFreemanMAChinTWYeoHWestMScottGRadiological and survival comparison of four methods of fixation of a proximal femoral stemJ Bone Joint Surg [Br]199779-B351–6010.1302/0301-620X.79B3.7060
12.
DuffyGPBerryDJRowlandCCabanelaMEPrimary uncemented total hip arthroplasty in patients <40 years old: 10–14-year results using first-generation proximally porous-coated implantsJ Arthroplasty2001168 Suppl 1140–410.1054/arth.2001.28716
13.
FalezFCasellaFPanegrossiGFavettiFBarresiCPerspectives on metaphyseal conservative stemsJ Orthopaed Traumatol2008949–5410.1007/s10195-008-0105-4
14.
FinkBSiegmullerCSchneiderTConradSSchmielauGRutherWShort- and medium-term results of the thrust plate prosthesis in patients with polyarthritisArch Orthop Trauma Surg2000120294–29810.1007/s004020050468
15.
FinkBWesselSDeuretzbacherGProtzenMRutherWMidterm results of “thrust plate” prosthesisJ Arthroplasty2007225703–71010.1016/j.arth.2006.12.041
16.
FreemanMARWhy Resect the Neck?J Bone Joint Surg Br198668-B3346–349
17.
FreemanMARPlante-BordeneuvePEarly migration and late aseptic failure of proximal femoral prosthesisJ Bone Joint Surg [Br]199476-B432–8
18.
GillIRGillKJayasekeraNMillerJMedium term results of the collum femoris preserving hydroxyapatite coated total hip replacementHip Int200818275–80
19.
GruenTAMcNeiceGMAmstutzHCModes of failure of cemented stem-type femoral components: a radiographic analysis of looseningClin Orthop197914117–27
20.
HugglerAHJacobHABereiterHHaferkornMRyfCSchenkRLong-term results with the uncemented thrust plate prosthesis (TPP)Acta Orthop Belg199359Suppl1215–23
21.
JourneauxSFMorganDAFDonnellyWJThe medium-term results of a cemented Freeman femoral neck-retaining prosthesisJ Bone Joint Surg [Br]200082-B188–9110.1302/0301-620X.82B2 .9752
22.
KaratosunVUnverBGunalIHip arthroplasty with the thrust plate prosthesis in patients of 65 years of age or older: 67 patients followed 2–7 yearsArch Orthop Trauma Surg2008128377–38110.1007/s00402-007-0487-4
23.
KaratosunVUnverBGultekinAGunalIA biomechanical comparison of the thrust plate prosthesis and a stemmed prosthesisHip Int2011215565–7010.5301/HIP.2011.8687
24.
LangtonDJJamesonSSJoyceTJHallabNJNatuSNargolAVEarly failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wearJ Bone Joint Surg2010921038–46
25.
LerchMvon der Harr-TanAWindhagenHBehrensBAWefstaedtPStukenborg-ColsmanCMBone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry studyInt Orthop2012363533–810.1007/s00264-011-1361-0
26.
MannanKFreemanMAScottGThe Freeman femoral component with hydroxyapatite coating and retention of the neck: an update with a minimum follow-up of 17 yearsJ Bone Joint Surg Br2010924480–510.1302/0301-620X.92B4.23149
27.
MartelliSTaddeiFSchileoECristofoliniLRushtonNVicecontiMBiomechanical robustness of a new proximal epiphyseal hip replacement to patient variability and surgical uncertainties: a FE studyMed Eng Phys2012342161–7110.1016/j.medengphy.2011.07.006
28.
McMinnDJPradhanCZiaeeHDanielJIs mid-head resection a durable conservative option in the presence of poor femoral bone quality and distorted anatomy?Clin Orthop Relat Res201146961589–9710.1007/s11999-010-1739-0
29.
MolfettaLCapozziMCaldoDMedium term follow up of the biodynamic neck sparing prosthesisHip Int201121176–8010.5301/HIP.2011.6296
30.
MooreATMetal hip joint: a new self-locking vitallium prosthesisS Med J195245111015–1910.1097/00007611-195211000-00001
31.
NowakMNowakTESchmidtRForstRKressAMMuellerLAProspective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae orientated pressfit cup: minimum 6-year follow-upArch Orthop Trauma Surg2011131549–5510.1007/s00402-010-1189-x
32.
NunnDFreemanMARTannerKEBonfieldWTorsional stability of the femoral component of hip arthroplasty. Response to an anteriorly applied loadJ Bone Joint Surg Br198971-B452–5
33.
OlsenMLewisPMWaddellJPSchemitschEHA biomechanical investigation of implant alignment and femoral neck notching with the Birmingham mid-Head ResectionJ Arthroplasty2010256112–710.1016/j.arth.2010.05.007
34.
OlsenMSellanMZderoRWaddellJPSchemitschEHA biomechanical comparison of epiphyseal versus metaphyseal fixed bone-conserving hip arthroplastyJ Bone Joint Surg Am2011932122–710.2106/JBJS.J.01709
35.
PipinoFCFP prosthetic stem in mini-invasive total hip arthroplastyJ Orthopaed Traumatol20044165–7110.1007/s10195-004-0065-2
36.
PipinoFCalderalePMBiodynamic total hip prosthesisItal J Orthop Traumatol1987133289–97
37.
PipinoFMolfettaLFemoral neck preservation in total hip replacementItal J Orthop Traumatol.19931915–12
38.
PipinoFKellerATissue-sparing surgery: 25 years’ experience with femoral neck preserving hip arthroplastyJ Orthopaed Traumatol2006736–4110.1007/s10195-006-0120-2
39.
PipinoFMolfettaLGrandizioMPreservation of the femoral neck in hip arthroplasty: results of a 13- to 17-year follow-upJ Orthopaed Traumatol20001131–910.1007/s101950070026
40.
RahmanLMuirhead-AllwoodSKThe Birmingham mid-head resection arthroplasty—a minimum two year clinical and radiological follow-up: an independent single surgeon seriesHip Int2011213356–6010.5301/HIP.2011.8407
41.
RajDJaiswalPKSharmaBLFergussonCMLong term results of the Corin C-Fit uncemented total hip arthroplasty in young patientsArch Orthop Trauma Surg2008128121391–510.1007/s00402-007-0557-7
42.
RohrlSMLiMGPedersenEUllmarkGNivbrantBMigration pattern of a short femoral neck preserving stemClin Orthop Relat Res200644873–810.1097/01.blo.0000224000.87517.4c
43.
SkinnerJAKroonPOTodoSScottGA femoral component with proximal HA coating. An analysis of survival and fixation at up to ten yearsJ Bone Joint Surg [Br]200385-B366–7010.1302/0301-620X.85B3.13054
44.
SteensWRosenbaumDGoetzeCGoshegerGvan den DaeleRSteinbeckJClinical and functional outcome of the Thrust Plate Prosthesis: short- and medium-term resultsClinical Biomechanics200318647–65410.1016/S0268-0033(03)00092-5
45.
SugiyamaHWhitesideLAKaiserADExamination of rotational fixation of the femoral component in total hip arthroplasty. A mechanical study of micromovement and acoustic emissionClin Orthop Relat Res1989249122–8
46.
SynderMDrobniewskiMPruszczynskiBSibinskiMInitial experience with short Metha stem implantationOrtop Traumatol Rehabil2009114317–23
47.
ThompsonFRTwo and a half years’ experience with a vitallium intramedullary hip prosthesisJ Bone Joint Surg Am195436-A3489–502
48.
WhitesideLAMcCarthyDSWhiteSERotational stability of noncemented total hip femoral componentsAm J Orthop (Belle Mead NJ)1996254276–80
49.
WhitesideLAWhiteSEMcCarthyDSEffect of neck resection on torsional stability of cementless total hip replacementAm J Orthop (Belle Mead NJ)19952410766–70
50.
Yasunaga Y, Yamasaki T, Matsuo T, Yoshida T, Oshima S, Hori J, Yamasaki K, Ochi M. Clinical and radiological results of 179 thrust plate hip prostheses: 5-14 years follow-up study. Arch Orthop Trauma Surg 2011; doi:10.1007/s00402-011-1434-y
