Abstract
Standard-length porous-coated tapered femoral stems perform exceedingly well in primary total hip arthroplasty (THA) at long-term follow-up. Nevertheless, there are multiple reasons to strongly consider the relatively new concept of short tapered stems. First, there is already a wide variation in the lengths of “standard” components and the ideal length is unknown. The goal of tapered stems is to load the proximal femur, and shortened stems accomplish this task. Second, while the distal extension may help prevent varus, unlike cemented stems, which are failure-prone with varus alignment, tapered designs are not. Additionally, elimination of the distal extension may reduce potential stress shielding. Third, short stems obviate problems with proximal-distal mismatch, excessive femoral bowing, diaphyseal deformities, and preexisting hardware. Fourth, implantation of smaller components requires less violation of bone and soft tissue, facilitating less invasive surgical approaches and favorable revision settings if necessary. Fifth, in comparison to hip resurfacing and other unconventional short-stem designs, tapered stems are familiar to most orthopedic surgeons and do not incur a steep learning curve. Finally, our early experience with this implant in 1750 THAs since 2006 has been excellent. In a series of >650 THA, compared to standard-length tapered stems, the short stem had equivalent clinical outcome scores, significantly fewer femoral fractures (12/389 [3.1%] vs 1/269 [0.4%]), and only 1 (1/269 [0.4%]) femoral revision (infection) at 2-year follow-up. Short stems represent the logical progression of a proven precedent in standard-length tapered stems.
- 1.Chang RW, Pellisier JM, Hazen GB. A cost-effectivness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996; 275(11):858–865.
10.1001/jama.275.11.858 Crossref Medline, Google Scholar - 2.Migliore A, Perrini MR, Romanini E, Comparison of the performance of hip implants with data from different arthroplasty registers. J Bone Joint Surg Br. 2009; 91(12):1545–1549.
10.1302/0301-620X.91B12.22692 Crossref Medline, Google Scholar - 3.Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011; 93(5):500–509.
10.2106/JBJS.J.00774 Crossref Medline, Google Scholar - 4.Mai KT, Verioti CA, Casey K, Slesarenko Y, Romeo L, Colwell CW. Cementless femoral fixation in total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2010; 39(3):126–130. Medline, Google Scholar
- 5.Lombardi AV, Berend KR, Adams JB. A short stem solution: through small portals. Orthopedics. 2009; 32(9). pii: orthosupersite.com/view.asp?rID=42833.
10.3928/01477447-20090728-09 . Link, Google Scholar - 6.Stulberg SD, Dolan M. The short stem: a thinking man’s alternative to surface replacement. Orthopedics. 2008; 31(9):885–886.
10.3928/01477447-20080901-37 Link, Google Scholar - 7.Berend KR, Mallory TH, Lombardi AV, Dodds KL, Adams JB. Tapered cementless femoral stem: difficult to place in varus but performs well in those rare cases. Orthopedics. 2007; 30(4):295–297. Link, Google Scholar
- 8.Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17(4):463–466.
10.1054/arth.2002.32171 Crossref Medline, Google Scholar - 9.Slover JD, Rubash HE. Hip resurfacing arthroplasty: time to consider it again? No. Instr Course Lect. 2008; (57):267–271. Medline, Google Scholar
- 10.Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. A short tapered stem reduces incidence of intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res. In press. Google Scholar
