Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2020; 11(11): 528-533
Published online Nov 18, 2020. doi: 10.5312/wjo.v11.i11.528
Use of short stems in revision of standard femoral stem: A case report
Francesco Roberto Evola, Giuseppe Evola, Giuseppe Sessa
Francesco Roberto Evola, Giuseppe Sessa, University of Catania, Department of Surgery, Clinic Orthopaedic, Catania 95124, Italy
Giuseppe Evola, General and Emergency Surgery Department, Surgery Clinic, Catania 95124, Italy
Author contributions: Evola FR reviewed the literature and contributed to conception and design of the study; Evola G contributed to drafting the article and making critical revisions related to important intellectual content of the manuscript; Sessa G revised the manuscript and approved the final version of the article.
Informed consent statement: Informed consent is not necessary for the study because the authors used anonymous clinical data and the patient died.
Conflict-of-interest statement: The authors declare that they have no conflict of interest and financial relationships for the realization of this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francesco Roberto Evola, MD, PhD, Assistant Professor, Doctor, University of Catania, Department of Surgery, Clinic Orthopaedic, Via Plebiscito 628, Catania 95124, Italy. robertoevola@virgilio.it
Received: June 10, 2020
Peer-review started: June 10, 2020
First decision: July 4, 2020
Revised: September 14, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: November 18, 2020
Abstract
BACKGROUND

Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip. In revision procedures for elderly patients with serious comorbidity, applying a short stem could reduce peri- and post-operative secondary surgical risks to femoral osteotomy, which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal. There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.

CASE SUMMARY

A male patient had a left hip replacement in 1995 due to coxarthrosis. At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh. The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex. The patient had various comorbidities (diabetes, anaemia, heart deficiency, and arrhythmia) presenting a high operation risk (ASA 4). During the revision procedure, the distal apex of the stem could not be removed from the femoral cortex. Because of the poor general health of the patient, the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant. The patient had his left femur X-rayed 15 d post-trauma.

CONCLUSION

A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.

Keywords: Short stem, Revision procedure, Cementless implant, Total hip replacement, Prosthesis design, Case report

Core Tip: Short stems, because of their reduced size, could be applied for post-traumatic obliteration of the femoral canal when it is difficult to apply a standard stem; moreover, in revision procedures for patients with serious comorbidity, the use of a short stem could reduce the surgical risks to femoral osteotomy, which is necessary for the removal of parts of the implant or acrylic cement from the medullary canal. The availability of cemented short stems could help surgeons in cases where there is a lack or reduced quality of bone to treat particular prosthetic revisions, limiting surgical invasiveness and the use of long stems.