Can Arthroplasty Stem INfluence Outcome? (CASINO): a randomized controlled equivalence trial of 125 mm versus 150 mm Exeter V40 stems in total hip arthroplasty

Trials. 2018 Apr 16;19(1):226. doi: 10.1186/s13063-018-2621-8.


Background: The use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation. However, cemented short-stem designs may increase the risk of varus stem malalignment and influence patient outcomes.

Methods/design: CASINO is a multi-centre randomised equivalence trial that will recruit 220 patients undergoing total hip arthroplasty for osteoarthritis at two NHS hospitals in Scotland. Patients will be aged 45-80, undergoing unilateral primary hip arthroplasty, with no plan for contralateral procedure within the study timeframe, and able to comply with the protocol. Participants will be randomised to receive either a short (125 mm) or a standard (150 mm) Exeter V40 stem. The Contemporary acetabular component will be used in all cases. All implants will be cemented. Patient pain, function and satisfaction will be assessed using change from baseline measurement in Oxford Hip Score, Forgotten Joint Score, EQ-5D, pain numerical rating scores, and patient satisfaction questionnaire at baseline and at 1 and 2 years following surgery. Radiographic assessment will evaluate stem position and will be appraised by independent reviewers. Patients will be blind to implant allocation.

Discussion: Stem length may be associated with outcome; however, we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty. The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems.

Trial registration: International Standard Randomised Controlled Trial Number, ISRCTN13154542 , Registered on 30 June 2017.

Keywords: Function; Outcomes; Total hip arthroplasty.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / instrumentation*
  • Biomechanical Phenomena
  • Disability Evaluation
  • Equivalence Trials as Topic
  • Female
  • Hip Joint / diagnostic imaging
  • Hip Joint / physiopathology
  • Hip Joint / surgery*
  • Hip Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / physiopathology
  • Osteoarthritis, Hip / surgery*
  • Pain Measurement
  • Prosthesis Design
  • Range of Motion, Articular
  • Recovery of Function
  • Scotland
  • Single-Blind Method
  • Time Factors
  • Treatment Outcome

Grant support