Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hauer, G.
Survival Rate of Short-Stem Hip Prostheses: A Comparative Analysis of Clinical Studies, National Arthroplasty Registers and Own Preliminary Results.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2020. pp. 97
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Amrein Karin
- Maurer-Ertl Werner
- Sadoghi Patrick
- Altmetrics:
- Abstract:
- Background: The aim of this thesis was to calculate the long-term revisions rates of short-stem hip prostheses from clinical studies and to compare these rates with data from national joint arthroplasty registers. The primary hypothesis was that sponsored or dependent studies performed better than independent clinical studies. Secondly, the thesis aimed to detect a possible difference in revision rates between different types of short-stems and surgical approaches. The third goal was to retrospectively analyse the first series of short-stem prostheses implanted at the Medical University of Graz in terms of migration rates. Methods: Three databases were comprehensively searched and studies were included if the study provided data on revision rate and was published between 2006 and 2020. The formula “revision per 100 component years” was used in order to compare different studies irrespective of number of hips implanted and different follow-up periods. For group analysis, studies were divided into independent and dependent clinical trials and the Australian National Arthroplasty Register could be used for comparison regarding revision rates. Additionally, short-stems were subdivided, depending on their femoral neck resection, into neck sparing (NS), neck retaining (NR) and neck harming (NH) stems. Einzel-Bild-Röntgen-Analyse (EBRA) was used to analyse the migration rate of the Optimys® short-stem. Results: Data were analysed from sixty-six studies with seventy cohorts. After one decade, the calculated median revision rate from all clinical trials was 4.2%, which is slightly less compared to 5.0% in the Australian register. Dependent data showed lower revisions rates in comparison to independent data, without reaching the criteria of significance. NR femoral stems revealed the worst outcome, while NH and NS prostheses performed comparably well. The posterior approach in combination with short-stem hip replacement is associated with longer implant survival. At 3 years postoperatively, the mean axial subsidence of the first 49 Optimys® short-stems was 3.0 mm. Up to now, no stem had to be revised. Conclusion: Calculated long-term NS and NH revision rates are acceptable and appear to be superior to NR rates. No publication bias could be detected regarding implant survival. There is a need for more clinical trials and joint registries providing sufficient data on short-stem hip prostheses. The migration analysis observed a migration pattern with initially pronounced subsidence followed by a subsequent settling. Therefore, a close monitoring of new implants and especially of implants with a noticeable migration pattern is recommended.