Short Bone-Conserving Stems in Cementless Hip Arthroplasty

Abstract

➤ 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.

Periprosthetic bone density changes after MiniHipTMcementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study

“…Cementless femoral stem fixation has now become the method of choice in total hip replacement (THR) [1]. The early cementless stems were either straight or curved and engaged the femur in proximal metaphysis as well as distally [2].…”

CORR Insights®: Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years

“…Although shortstem designs are not a new concept [1,2], there has been a growing interest in utilizing less-invasive techniques. This trend illustrates the progression towards bone-and tissue-sparing THA.…”

“…The stem design used in this study has been classified as a Type 3 stem, which means it loads the calcar and has a lateral flare, and extends just past the proximal femoral metaphysis [1]. With a tapered, trapezoidal geometry and lateral flare, this design achieves fixation in, and transfers load to, the calcar and lateral cortex.…”

“…With a tapered, trapezoidal geometry and lateral flare, this design achieves fixation in, and transfers load to, the calcar and lateral cortex. The lateral flare conforms to the proximal femoral geometry to load the lateral aspect of the femur more physiologically [1]. Using the classification system developed by Wright et al [3] that describes the grades of recommendation based on the overall quality of the available evidence, Khanuja et al stated there is insufficient evidence to recommend the routine use of Type 3 short stems at present [1].…”

Short Stem In Primary Total Hip Arthroplasty

“…In this respect, they proposed three types of stems: 1) metaphyseal stabilized; 2) neck stabilized; 3) head stabilized (resurfacing). Recently, Khanuja et al [12] classified short stems according with fixation principles and location of proximal loading. The authors distinguished four categories: 1) femoral neck fixation; 2) calcar loading; 3) lateral flare and calcar loading; and 4) shortened tapered.…”