Aims. The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. Methods. In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results. At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion. The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness. Cite this article: Bone Jt Open 2023;4(7):507–515

We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m. 2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2). At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1 neurogenic sciatic pain, 1 transient sciatic nerve palsy that recovered completely after six months, and 2 acute periprosthetic joint infections. One patient suffered a Vancouver B2 periprosthetic femoral fracture 45 days after surgery and was revised with a modular distally fixed uncemented fluted stem. A type 2B short stem evidenced promising outcomes at short to medium-term follow up in young adult patients with PFDs, avoiding the need for corrective osteotomies and a revision stem

The use of short stems has become more popular with the increased interest in less invasive approaches for total hip arthroplasty. The curved broaches and stem can be inserted along a curved track to avoid the abductor attachments. Short stems have the potential of being more bone conserving by allowing for higher neck retention, maintenance of the medial greater trochanter, and preferential stress transfer to the proximal femur. An initial experience with 500 new short stems (Fitmore, Zimmer Orthopedics) stems used for total hip arthroplasty is reported. No stems have been revised for aseptic loosening

Conventional uncemented femoral implants provide dependable long-term fixation in patients with a wide range of functional requirements. Yet challenges associated with proximal–distal femoral dimensional mismatch, preservation of bone stock, and minimally invasive approaches have led to exploration into alternative implant designs. Short stem designs focusing on a stable metaphyseal fit have emerged to address these issues in total hip replacement (THR). Uncemented metaphyseal-engaging short stem implants are stable and are associated with proximal bone remodeling closer to the metaphysis when compared with conventional stems and they also have comparable clinical performances. Short stem metaphyseal-engaging implants can meet the goals of a successful THR, including tolerating a high level of patient function, as well as durable fixation. Cite this article: Bone Joint J 2013;95-B, Supple A:57–62

Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant. Methods. All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study. Results. Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. Fifty-two hips (18%) had ≥25% cortical hypertrophy in zone 3 and 91 hips (31%) had ≥25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusion. The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient reported anterior or lateral thigh pain. For any tables or figures, please contact the authors directly

Aims. Although the short stem concept in hip arthroplasty procedure shows acceptable clinical performance, we sometimes get unexplainable radiological findings. The aim of this retrospective study was to evaluate changes of radiological findings up to three years postoperatively, and to assess any potential contributing factors on such radiological change in a Japanese population. Methods. This is a retrospective radiological study conducted in Japan. Radiological assessment was done in accordance with predetermined radiological review protocol. A total of 241 hips were included in the study and 118 hips (49.0%) revealed radiological change from immediately after surgery to one year postoperatively; these 118 hips were eligible for further analyses. Each investigator screened whether either radiolucent lines (RLLs), cortical hypertrophy (CH), or atrophy (AT) appeared or not on the one-year radiograph. Further, three-year radiographs of eligible cases were reviewed to determine changes such as, disappeared (D), improved (I), stable (S), and progression (P). Additionally, bone condensation (BC) was assessed on the three-year radiograph. Results. CH was observed in 49 hips (21.1%), AT was observed in 63 hips (27.2%), and RLLs were observed in 34 hips (14.7%) at one year postoperatively. Among 34 hips with RLLs, 70.6% showed change of either D or I on the three-year radiograph. BC was observed in younger patients more frequently. Conclusion. The Fitmore stem works well in a Japanese population with favourable radiological change on hips with RLLs. Longer-term follow-up is required to determine clinical relevance. Cite this article: Bone Jt Open 2022;3(1):20–28

Cementless stem designs in total hip arthroplasty differ in relation to geometry and area of fixation. We utilised radiostereometric analysis (RSA) to evaluate the 2-year migration of a novel, short, proximally coated femoral stem. 30 participants undergoing primary total hip replacement for any cause (rheumatoid or inflammatory arthritis, osteoarthritis) were prospectively recruited in this study. Osteoporotic patients and cases of suspected infection were excluded. All patients received a short blade stem, proximally coated with a reduced lateral shoulder and narrow triple taper geometry to minimise bone removal. RSA radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2 years. The Harris Hip Score (HHS), Oxford Hip Score (OHS) and EQ-5D were collected at baseline and at 2 years post-operatively. The stability of implants and complications were captured during each follow-up visit. A total of 14 female and 16 male patients were recruited with a mean age of 64.8 (range 47 to 75). At two years the mean subsidence of the stem was 0.34 mm (SD 0.62) and the total migration 0.74 mm (SD 0.60). The mean medial translation at two years was 0.059 (0.24) and the mean anterior translation 0.12 (0.59) respectively. Baseline PROM scores improved significantly at 2-years from pre-operatively (median and interquartile range): HHS from 33 (18.25) to 92 (19), EQ5D from 0.5 (0.35) to 0.94 (0.17), OHS from 21 (18.25) to 42 (4.25). P-value for all comparisons was <0.001. 2-year follow up data revealed no complications. There were no stem revisions in study participants and no heterotopic ossifications were identified on radiographs. 2-year migration results of a cementless, short blade, proximally coated tapered femoral stem using RSA, showed the stem exhibits a predictable migration pattern and achieves initial stability. This is highly likely to translate to mid and long-term stability, which needs to be corroborated by long-term outcome studies. Furthermore, participants demonstrated excellent clinical, patient reported and radiological outcomes after 2 years of follow up to support expansion in the use of this prosthesis

Cement-in-cement femoral revision is a proven technique in revision total hip arthroplasty, with excellent results when using standard sized Exeter stems. The Exeter 44/00 125 mm short revision stem was introduced in 2004 to facilitate cement-in-cement revision. The stem is 25mm shorter and has a slimmer body to allow greater flexibility to adjust depth of insertion and version of the stem. However, it is not known if this change in stem length and size effects its longer term performance. We therefore reviewed the clinical outcome and survival of the Exeter 44/00 short stem used for cement-in-cement revision in our unit, with a minimum of 5 years follow up. 166 cases were performed between 2004 and 2010. 103 hips were available for 5 year clinical and radiological follow up, with 91 hips surviving to final review in 2017. At 5 years, 43 hips had died, 13 were revised and 7 were too frail to attend clinical review. The fate of all 166 hips were known and included in the survival analysis. Median clinical scores improved significantly. Sixteen hips required re-revision (infection 6, loose cup 3, periprosthetic fracture 3, instability 2, stem fracture with chronic infection 1 and pain 1). Kaplan-meier survival analysis revealed 100% survival for aseptic loosening, 96.8% survival for stem failure and 88.9% survival for all causes. This is the largest series with the longest follow up of the Exeter 44/00 short revision stem. The stem performs equally well as standard Exeter stems with regards to aseptic loosening. The single stem fracture occurred secondary to bone loss in chronic infection, highlighting the importance of providing adequate proximal support for the stem. Periprosthetic fracture occurred in 2.4% of this series of revision cases. Larger registry-based studies may provide additional information on the performance of this stem

The purposes of this study were to review retrospectively the 10-year outcome of cementless total hip arthroplasty (THA) using an active robot system in the femoral canal preparation for an anatomic short stem and navigation in the cup placement through a mini incision posterior approach. We reviewed all patients who underwent THA with this procedure in 53 hips between 2004 and 2007. There were no intraoperative fracture nor navigation- or robotic-related complications. All implant sizes were same as planned ones. All cases were followed up at least two years and all implants showed bone ingrowth stable according to the Engh's criteria. After then, six patients died of unrelated causes. Two patients (three hips) could not come to the 10-year follow-up examination. The remaining 44 hips were followed for 10 to 12 years (11 years on average). There is no dislocation. The average JOA hip score improved from 48 preoperatively to 96 at the final examination. On the postoperative x-ray measurements, the average cup radiographic inclination was 39° and the radiographic anteversion was 14°. There was no stem which showed more than 2° of varus or valgus alignment. There was no case who showed more than 5mm of limb length discrepancy. Postoperative CT images of 38 hips were obtained at 2 weeks. After matching the coordinates of the pelvis and femur with the preoperative planning, we got very small differences in alignment parameters between the measured values and the planed ones. The difference differences between the plan and measured values were −0.1° in cup inclination, −1.4° in cup anteversion, stem 0.5° in coronal alignment, 0.6° in stem sagittal alignment, and −1.6° in stem anteversion, respectively. We conclude that our robotic femoral preparation for a short anatomical stem and navigated cup placement thru a mini-posterior approach was safe and feasible without affecting the accuracy of the procedure. There were no long term adverse effect of the procedure

Introduction. The removal of a well fixed cement mantle for revision of a total hip replacement (THR) can be technically challenging and carries significant risks. Therefore, a cement-in-cement revision of the femoral component is an attractive option. The Exeter Short Revision Stem (SRS) is a 125 mm polished taper stem with 44 mm offset specifically designed for cement-in-cement revisions. Only small series using this implant have been reported. Patients/Materials & Methods. Records for all patients who had undergone a cement-in-cement revision with the SRS were assessed for 1) radiological femoral component loosening 2) clinical femoral component loosening 3) further revision of the femoral component 4) complications. We assessed serial radiographs for changes within the cement mantle and for implant subsidence. Results. 50 implants in 46 patients were reviewed. Mean age at surgery was 67.7 (range 39–88) years. 7 patient (8 implant) deaths at mean 128 (range 17 – 267) weeks following surgery were identified. Complications included one intra-operative greater trochanter fracture, one femoral nerve palsy, and one early infection following surgery. Three implants required revision. One at 11 weeks following surgery for recurrent dislocation, one at 138 weeks for infection and one at 290 weeks for breakage of the femoral implant. The mean time from surgery to both radiographic and clinical follow-up was 3.4 years. Radiographs available for 48 implants showed no radiographic evidence of loosening. Clinical follow-up information was available for 45 patients. Only one patient reported thigh pain but a bone scan showed no evidence of loosening. Discussion. This is the largest reported series with SRS we are aware of outside the design centre. Conclusions. The Exeter Short Revision Stem provides a viable option for cement-in-cement revision surgery. Further evaluation of the use of this implant in patients with a high BMI is required given the implant failure in this series and the reported literature

Although data on uncemented short stems are available, studies on cemented short-stemmed THAs are limited. These cemented short stems may have inferior long-term outcomes and higher femoral component fracture rates. Hence, we examined the long-term follow-up of cemented short Exeter stems used in primary THA. Within the Exeter stem range, 7 stems have a stem length of 125 mm or less. These stems are often used in small patients, in young patients with a narrow femoral canal or patients with anatomical abnormalities. Based on our local database, we included 394 consecutive cemented stems used in primary THA (n=333 patients) with a stem length ≤125 mm implanted in our tertiary referral center between 1993 and December 2021. We used the Dutch Arthroplasty Registry (LROI) to complete and cross-check the data. Kaplan-Meier survival analyses were performed to determine 20-year survival rates with stem revision for any reason, for septic loosening, for aseptic loosening and for femoral component fracture as endpoints. The proportion of male patients was 21% (n=83). Median age at surgery was 42 years (interquartile range: 30–55). The main indication for primary THA was childhood hip diseases (51%). The 20-year stem survival rate of the short stem was 85.4% (95% CI: 73.9–92.0) for revision for any reason and 96.2% (95%CI: 90.5–98.5) for revision for septic loosening. No stems were revised for aseptic femoral loosening. However, there were 4 stem fractures at 6.6, 11.6, 16.5 and 18.2 years of follow-up. The stem survival with femoral component fracture as endpoint was 92.7% (CI: 78.5–97.6) at 20 years. Cemented short Exeter stems in primary THA show acceptable survival rates at long-term follow-up. Although femoral component fracture is a rare complication of a cemented short Exeter stem, orthopaedic surgeons should be aware of its incidence and possible risk factors

In this RCT the primary aim was to assess whether a short (125mm) Exeter V40 stem offered an equivalent hip specific function compared to the standard (150mm) stem when used for cemented total hip arthroplasty (THA). Secondary aims were to evaluate health-related quality of life (HRQoL), patient satisfaction, stem height and alignment, radiographic loosening, and complications between the two stems. A prospective multicentre double-blind randomised control trial was conducted. During a 15-month period, 220 patients undergoing THA were randomised to either a standard (n=110) or short (n=110) stem Exeter. There were no significant (p≥0.065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at 1- and 2-years. There were no differences (p=0.428) in hip specific function according to the Oxford hip score at 1-year (primary endpoint) or at 2-years (p=0.767) between the groups. The short stem group had greater varus angulation (0.9 degrees, p=0.003) when compared to the standard group and were more likely (odds ratio 2.42, p=0.002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (p≥0.083) differences in the Forgotten joint scores, EuroQol-5-Dimension, EuroQol-VAS, Short form 12, patient satisfaction, complications, stem height or radiolucent zones at 1 or 2-years between the groups. The Exeter short stem offers equivalent hip specific function, HRQoL, patient satisfaction, and limb length when compared to the standard stem at 2-years post-operation. However, the short stem was associated with a greater rate of varus malalignment which may influence future implant survival

Short-stem total hip arthroplasty (THA) may have bone sparing properties, which could be advantageous in a younger population with high risk of future revision surgery. We used data from the AOANJRR, LROI and SAR to compare survival rates of primary THA, stems used in the first-time revision procedures as well as the overall survival of first-time revisions between a cohort of short-stem and standard-stem THA. Short-stem THAs (designed as a short stem with mainly metaphyseal fixation) between 2007 and 2021 were identified (n=16,258). A propensity score matched cohort (1:2) with standard THAs in each register was identified (n=32,515). The cohorts were merged into a research dataset. Overall survival at 12 years follow-up was calculated using Kaplan-Meier survival analyses. Stem revisions (short-stem THA n=239, standard-stem THA n=352) were identified. The type of revision stem was classified as standard (<160 mm) or long (>160 mm). The survival rate of all first-time revisions in the two groups was calculated using any type of revision as outcome. The 12 year- overall survival rate (all revisions, all causes) for primary short-stem THAs was 95.3% (CI 94.5–95.9%), which was comparable to 95.2% (CI 94.7–95.7%) for standard-stem THAs. In the short-stem THA group, a standard stem (<160 mm) was more often (59%) used in the first-time revision than in the standard-stem group (47%, p=0.004). The overall survival of the first-time revisions did not differ between cases primarily operated with a short or a standard stem. In our multi-national register study, the overall survival rate of short stems was similar to that of standard stems. In short stem revisions there was a higher likelihood of using a standard-length stem for the revision compared with first-time revisions of standard stems. This finding might indicate bone-sparing properties with short-stemmed THAs

Post-operative peri-prosthetic femoral fracture (PO-PPFF) is one of the most relevant complications in primary Total Hip Arthroplasty (pTHA), accountable for a significant clinical and socio-economic burden both in revision and fixation settings. We retrospectively reviewed of our series of 1586 cementless total hip arthroplasty performed between 1999 and 2019 (achieving a minimum of 5-years follow-up) with different short stems. We have observed a cumulative low incidence of PO-PPFF of 0,33% (5 cases): we divided Po-PPFF in two groups: fracture occurred around a short stem (A) and around a standard shortened stem (B), according to French Hip & Knee Classification of Short Stems. Despite the length of observed period (mean follow-up 12 years, min 5 years max 24 years) a total of 1512 cases (mean age at surgery 61 years, max 74, min 40 years) were available to clinical and radiographic follow-up, being this population enrolled in elective surgery clinical protocols. Our data exceed the low incidence of post-operative femoral fracture around bone -preserving previously reported by Kim in 2018 (12 fracture out of 1089 cases:1.1%). No correlation have been observed among occurrence of PO-PPF age of the patient and no fracture occurred around cemented short stems despite patient's characteristics were unfavourable in term of age and bone quality. This result is not unexpected, giving the lower incidence of peri-prosthetic fracture even cemented conventional stems, as reported in all registry and systematic reviews. A similar behaviour was reported in 2020 Australian Joint Registry, where Post-operative periprosthetic femoral fracture showed a steep curve in early period, but remaining firmly below 1% during the following 12 years. Our clinical data seems to confirm previous studies by Jones (conducted on synthetic bone and fresh-frozen cadaveric femurs) where higher fracture angles and higher fracture torque were detected in short hips compared to standard stems

Revision total hip arthroplasty (rTHA) in the presence of femoral defects can be technically challenging. Reconstruction with long stems is widely accepted as the standard. However long stems can be difficult to insert and can compromise distal bone stock for future revisions. The aims of this study were to identify whether there was a difference in survival and outcomes following rTHA using a long versus standard or short femoral stem. A comprehensive systematic review was performed according to PRISMA guidelines using the MEDLINE, EMBASE, Chochrane Library and Web of Science databases. Inclusion criteria were (i) adult patients >18 years; (ii) randomised controlled trials, joint registry, or cohort studies; (iii) single or staged rTHA for Paprosky 1–3B femoral defects. Exclusion criteria were (i) mixed reporting without subgroup analysis for revision stem length; (ii) ex-vivo studies. Screening for eligibility and assessment of studies was performed by the authors. Out of 341 records, 9 studies met criteria for analysis (including 1 study utilising joint registry data and 1 randomised controlled trial). Across studies there were 3102 rTHAs performed in 2982 patients with a mean age of 67.4 years and a male: female ratio of 0.93. Revision prostheses were long-stemmed in 1727 cases and short or standard in 1375 cases with a mean follow up of 5 years (range, 0-15 years). On subgroup analysis the use of a long cemented stem compared to a long cementless prosthesis was associated with fewer complications and periprosthetic fracture in older patients. Survivorship was 95% with short stems compared to 84% with long stems at 5 years. Moderate quality evidence suggests that in rTHA with Paprosky type 1-3B femoral defects, the use of a short or standard stem can achieve comparable outcomes to long stems with fewer significant complications and revisions. Using a shorter stem may yield a more straightforward surgical technique and can preserve distal bone stock for future revision

Short stems have been developed to conserve bone stock, especially in younger populations undergoing a total hip arthroplasty (THA), and showed similar functional outcomes compared to conventional stems. Recent literature suggested that stem length might be an independent risk factor for acute periprosthetic femoral fracture in direct anterior THA (1) or with different short stem designs (2). The purpose of the present study was to compare the incidence of acute periprosthetic femoral fractures, between stems of the same manufacture (Taperloc microplasty vs Taperloc complete), which have the same stem characteristics, except for the stem length which is 35 mm shorter in Taperloc microplasty during posterior and lateral THA. Our institution's arthroplasty database was searched for all primary total hip arthroplasties utilizing short femoral stems performed between August 2016 and August 2023. Pre-operative X-rays for each case were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for periprosthetic fractures. For the time period assessed, 2107 femoral stems (Taperloc Microplasty:1727, Taperloc complete: 380) were implanted. Females constituted 53% of the cohort. The average patient age was 70±11 years. The periprosthetic fracture rate was 0.94%, with 20 periprosthetic fractures (Taperloc Microplasty:17, Taperloc complete: 3) excluding 2 greater trochanteric fractures (1 at each group), identified at follow-up of three months. There was no significant difference between the periprosthetic fracture rates between the two stems (0.98% vs 0.79%, p>0.72) The multivariate regression analysis demonstrated that the stem length, CBR, CFI, age, and gender were not risk factors for periprosthetic fracture. The present study demonstrated that both Taperloc Microplasty and Taperloc complete stems had similar rates of periprosthetic fractures, and the stem length was not a risk factor for a periprosthetic fracture during uncemented THA. 1. Tamaki T, Cementless Tapered-Wedge Stem Length Affects the Risk of Periprosthetic Femoral Fractures in Direct Anterior Total Hip Arthroplasty. J Arthroplasty. 2018 Mar;33(3):805-809. 2. Staunton P. Acute Periprosthetic Hip Fracture with Short Uncemented Femoral Stems. J Arthroplasty 2024 accepted

Aims. The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a short stem (Collum Femoris Preserving; CFP) with a conventional uncemented stem (Corail). Methods. Of 81 patients who were initially enrolled, 71 were available at five years’ follow-up. The outcomes at two years have previously been reported. The primary outcome measure was the clinical result assessed using the Oxford Hip Score (OHS). Secondary outcomes were the migration of the stem, measured using radiostereometric analysis (RSA), change of bone mineral density (BMD) around the stem, the development of radiolucent lines, and additional patient-reported outcome measures (PROMs). Results. There were no statistically significant differences between the groups regarding PROMs (median OHS (CFP 45 (interquartile range (IQR) 35 to 48); Corail 45 (IQR 40 to 48); p = 0.568). RSA showed stable stems in both groups, with little or no further subsidence between two and five years. Resorption of the femoral neck was evident in nine patients in the CFP group and in none of the 15 Corail stems with a collar that could be studied. Dual X-ray absorbiometry showed a significantly higher loss of BMD in the proximal Gruen zones in the CFP group (mean changes in BMD: Gruen zone 1, CFP -9.5 (95% confidence interval (CI) -14.8 to -4.2), Corail 1.0 (95% CI 3.4 to 5.4); Gruen zone 7, CFP -23.0 (95% CI -29.4 to -16.6), Corail -7.2 (95% CI -15.9 to 1.4). Two CFP stems were revised before two years’ follow-up due to loosening, and one Corail stem was revised after two years due to chronic infection. Conclusion. The CFP stem has a similar clinical outcome and subsidence pattern when compared with the Corail stem. More pronounced proximal stress-shielding was seen with the CFP stem, suggesting diaphyseal fixation, and questioning its femoral neck-sparing properties in the long term. Cite this article: Bone Joint J 2022;104-B(5):581–588

Aims. The aim of this study was to compare early functional and health related quality of life outcomes (HRQoL) in patients who have undergone total hip arthroplasty (THA) using a bone conserving short stem femoral component and those in whom a conventional length uncemented component was used. Outcome was assessed using a validated performance based outcome instrument as well as patient reported outcome measures (PROMs). Patients and Methods. We prospectively analysed 33 patients whose THA involved a contemporary proximally porous coated tapered short stem femoral component and 53 patients with a standard conventional femoral component, at a minimum follow-up of two years. The mean follow-up was 31.4 months (24 to 39). Patients with poor proximal femoral bone quality were excluded. The mean age of the patients was 66.6 years (59 to 77) and the mean body mass index was 30.2 kg/m. 2. (24.1 to 41.0). Outcome was assessed using the Oxford Hip Score (OHS) and the University College Hospital (UCH) hip score which is a validated performance based instrument. HRQoL was assessed using the EuroQol 5D (EQ-5D). Results. There were no major peri-operative complications. There was no difference in the mean post-operative OHS, EQ-5D or function subscale of the UCH hip scores between the two groups. The mean pre-operative OHS and EQ-5D scores improved significantly (all p <  0.001). The mean functional component of the UCH hip score at final follow-up was 42.5 and 40.6 in the short stem and conventional stem groups, respectively. There was no statistically significant difference between the groups (p = 0.42). A total of seven patients (21.2%) in the short stem group and nine (16.98%) in the conventional group achieved a ceiling effect using the OHS; none did using the function subscale of the UCH hip score. Conclusion. The proximally porous coated tapered short stem femoral component achieves comparable short-term functional outcomes when compared with a conventional longer stem uncemented femoral component when THA is undertaken in patients with good bone quality. Cite this article: Bone Joint J 2017;99-B(4 Supple B):49–55

The purpose of this study was to investigate the influence of surgical approach on femoral stem version in THA. This was a retrospective database review of 830 THAs in 830 patients that had both preoperative and postoperative CT scans. All patients underwent staged bilateral THAs and received CT-based 3D planning on both sides. Stem version was measured in the second CT-scan and compared to the native neck axis measured in the first CT-scan, using the posterior condyles as the reference for both. Cases were performed by 104 surgeons using either a direct anterior (DAA, n=303) or posterior (PA, n=527) approach and one of four stem designs: quadrangular taper, calcar-guided short stem, flat taper and fit-and-fill. Sub-analyses investigated changes in version for low (≤5°), neutral (5–25°) and high (≥25°) native version subgroups and for the different implant types. Native version was not different between approaches (DAA = 12.6°, PA = 13.6°, p = 0.16). Overall, DAA stems were more anteverted relative to the native neck axis vs PA stems (5.9° vs 1.4°, p<0.001). This trend persisted in hips with high native version (3.2° vs -5.3°, p<0.01) and neutral native version (5.3° vs 1.3°, p<0.001), but did not reach significance in the low native version subgroup (8.9° vs 5.9°, p=0.13). Quadrangular taper, calcar-guided, and flat taper stem types had significantly more anteversion than native for DAA, while no differences were found for PA. Stems implanted with a direct anterior approach had more anteversion than those implanted with a posterior approach. The smaller surgical field, soft tissue tension and lack of a “tibial” vertical reference frame may contribute to this finding

Short cementless femoral stems are increasingly popular as they allow for less dissection for insertion. Use of such stems with the anterior approach (AA) may be associated with considerable per-operative fracture risk. This study's primary aim was to evaluate whether patient-specific femoral- and pelvic- morphology and surgical technique, influence per-operative fracture risk. In doing so, we aimed to describe important anatomical thresholds alerting surgeons. This is a single-centre, multi-surgeon retrospective, case-control matched study. Of 1145 primary THAs with a short, cementless stem inserted via the AA, 39 periprosthetic fractures (3.4%) were identified. These were matched for factors known to increase fracture risk (age, gender, BMI, side, Dorr classification, stem offset and indication for surgery) with 78 THAs that did not sustain a fracture. Radiographic analysis was performed using validated software to measure femoral- (canal flare index [CFI], morphological cortical index [MCI], calcar-calcar ratio [CCR]) and pelvic- (Ilium-ischial ratio [IIR], ilium overhang, and ASIS to greater trochanter distance) morphologies and surgical technique (% canal fill). Multivariate and Receiver-Operator Curve (ROC) analysis was performed to identify predictors of fracture. Femoral factors that differed included CFI (3.7±0.6 vs 2.9±0.4, p<0.001) and CCR (0.5±0.1 vs 0.4±0.1, p=0.006). The mean IIR was higher in fracture cases (3.3±0.6 vs 3.0±0.5, p<0.001). % Canal fill was reduced in fracture cases (82.8±7.6 vs 86.7±6.8, p=0.007). Multivariate analysis and ROC analyses revealed a threshold CFI of 3.17 was predictive of fracture (sensitivity:84.6% / specificity:75.6%). Fracture risk was 29 times higher when patients had CFI>3.17 and II ratio>3 (OR:29.2 95%CI: 9.5–89.9, p<0.001). Patient-specific anatomical parameters are important predictors of fracture-risk. When considering the use of short stems via the AA, careful radiographic analysis would help identify those at risk in order to consider alternative stem options