A comparison of short-stem prostheses and conventional stem prostheses in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: In total hip arthroplasty (THA), short-stem prostheses (SS) were designed to achieve better preservation of proximal femoral bone stock and stability than conventional stem prostheses (CS), however these effects are controversial. We aimed perform a systematic review and meta-analysis to evaluate the effectiveness of SS and CS in primary THA.Methods: Relevant randomized controlled trials (RCTs) involving the comparison of SS and CS in primary THA were screened using the electronic databases PubMed, Embase and Web of Science. Data were analyzed with the RevMan 5.3 software program and evaluated with mean difference (MD), risk ratio (RR) and 95% confidence intervals (CIs) by random or fixed-effect models.Results: Sixteen RCTs involving 1,233 patients (1,486 hips) were included. Compared with CS, the incidence of thigh pain was significantly reduced with Proxima SS (RR 0.13, 95% CI, 0.03-0.51; P=0.004).Bone mineral density (BMD) with femoral neck-preserved SS [SS (I)] showed less decrease in Gruen zone 1

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

“…The shortened stem is metaphyseal‐filling and has a more curved shoulder than the conventional stem, thus may result in a smaller force against the calcar and the greater trochanter; furthermore, the shorter length requires a smaller femoral exposure, which is easier to achieve with the direct anterior approach. It is worth noting that shortened stems are more easily extracted than conventional stems during revision THA, and preserve diaphyseal bone stock for future revisions [23, 44].…”

“…The length of cementless femoral stems for primary total hip arthroplasty (THA) has evolved over the last decades. In recent years, the use of short stems has increased, as they preserve diaphyseal bone stock for future revisions, decrease stress shielding at the proximal femur, and are more easily implanted through minimally invasive approaches [23, 44]. According to the cementless stem classification by Kheir et al [17], short stems can be classified into four types, (i) femoral neck, (ii) calcar loading, (iii) calcar loading with lateral flare, and (iv) shortened tapered.…”

“…Five systematic reviews have directly compared conventional versus short stems [1, 12, 23, 43, 44], concluding that clinical outcomes and survival rates were similar. In contrast, radiographic outcomes were not widely evaluated; three systematic reviews reported contradictory findings regarding bone mineral density [23, 43, 44], while one systematic review reported no significant differences in femoral offset and limb length discrepancy [12].…”

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

“…In the study of Guo et al, the rate of thigh pain was 0% at a mean follow-up of 48 months [ 11 ]. Two meta-analyses emphasized that short stems decreased the incidence of thigh pain [ 41 , 42 ]. This superiority of short stem might be related to the reduced proximal stress shielding and the development of excellent mechanical transmission [ 43 ].…”

“…Tri-Lock BPS stem can stock the proximal femoral bone from loss and get the primary stability by a metaphyseal fixation. The unique design reduced the incidence of the distal medullary cavity being invaded and stress shielding [ 41 ].…”