A number of cementless femoral stems are associated with excellent long-term survivorship. Cementless designs differ from one another in terms of geometry and the means of obtaining initial fixation. Strict classification of stem designs is important in order to compare results among series. Loosening and thigh pain are less prevalent with modern stem designs. Stress-shielding is present in most cases, even with newer stem designs.

➤ Short bone-conserving femoral stems in total hip arthroplasty were designed to preserve proximal bone stock.➤ Given the distinct fixation principles and location of loading among these bone-conserving stems, a classification system is essential to compare clinical outcomes.➤ Due to the low quality of currently available evidence, only a weak recommendation can be provided for clinical usage of certain stem designs, while some other designs cannot be recommended at this time.➤ A high prevalence of stem malalignment, incorrect sizing, subsidence, and intraoperative fractures has been reported in a subset of these short stem designs.➤ Stronger evidence, including prospective multicenter randomized trials comparing standard stems with these newer designs, is necessary before widespread use can be recommended.

Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty. Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms. Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease.

Total hip and knee arthroplasty in dialysis-dependent patients presents high risk, with inpatient mortality rates ten to twenty times greater and overall complication rates two times greater than in non-dialysis-dependent patients. Arthroplasty should be approached with caution and preferably should be delayed until after renal transplantation.