Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients

The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA.

In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated. The mean follow-up was 3.25 years (SD 0.45). Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction were obtained using the visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignement and signs of aseptic loosening. Complications were documented.

At last follow-up, clinical outcome was excellent (HHS ≥ 90) in 5 patients and good (HHS = 87) in 1 patient. The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fracture were obvious. No major complications occurred. To date, no further revision surgery was needed.

The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group. Clinical and radiological results are encouraging. Based on the present data, short stems may be considered as a revision implant for failed HRA for experienced surgeons.