A Single Femoral Component for All Total Hip Replacements Performed by a Trust? Does This Affect Early Clinical and Radiological Outcomes?

Hospitals may be under pressure to implement cost saving strategies regarding prosthesis choice. This may involve the use of components which are not the first preference of individual surgeons, or those they have little experience with. We aim to examine the effect of standardizing the type of femoral stem used in a single trust, and determine whether this is safe practice, particularly in those who have never used this particular stem before.
We report results at 2 years of 151 primary total hip arthroplasties performed using a single femoral stem. Data was split into 2 groups: those in which the operating surgeon was previously using this femoral stem, and those who were not. Radiographic outcomes measured were leg length discrepancy, cement mantle grade, and femoral stem alignment. We also report on clinical outcomes, complications, and construct survivability.
No significant differences in clinical outcomes were observed. Cement quality was generally worse in those with no prior use of this stem. Leg length inequality was greater in those previously using the stem (.57mm vs 3.83mm), however this did not correlate to clinical outcomes. Alignment was similar between the groups (P=0.464).
Our findings suggest that although clinical outcomes are similar at 2 years, radiological differences can be observed even at this early stage in follow up. Choice of components for arthroplasty should remain surgeon led until long term follow up studies can prove otherwise.