Short femoral stems with metaphyseal or meta-diaphyseal fitting in total hip arthroplasty: a systematic review

  • I. Tatani
  • K. Solou
  • P. Megas
Keywords: Total Hip Arthroplasty; Short Femoral Stems; Metaphyseal Fitting


Background: Great variety of short stem designs have been introduced in the market in order to find the ideal combination of bone and soft tissue preservation, optimal stress distribution, excellent functional outcome and survival rates.

Purpose: Summarize and analyze the published data, in terms of clinical and radiological outcomes, complications, revision rates, and implant survival, on tapered-wedge short femoral stems which have metaphyseal only or metaphyseal-proximally diaphyseal fixation and require conventional neck osteotomy.

Methods: Review of literature databases, using the MEDLINE, Embase, and Web of Science, was conducted based on strict inclusion and exclusion criteria to identify studies reporting clinical and radiological outcomes for this specific type of short femoral stems.

Results: Thirty-six studies involving 3535 patients (3786 hips) with a mean age of 61.3 (27.5-74.42) years in a mean follow up of 45.54 (12-120) months were included. Mean Harris Hip Score improved from 45.72 (27.29-60) to 91.44 (83.1–100). The mean University of California at Los Angeles activity level and mean Merle d’Aubigné functional score was improved from 3.71 (3-3.9) to 6.06 (4.7-7.5) and 10.4 (8.5–11.5) to 17.29 (15.5–17.8) points, respectively. Femoral stem was implanted in neutral coronal alignment in 63.6% hips. A total of 30 studies reported revision rate, which was 0.03% (0-17%) and 12 studies presented component survivorship, which was 99% (96-100%) in average of 5.5 years.

Conclusions: Short, tapered-wedge stems with metaphyseal or meta-diaphyseal fitting demonstrate similar excellent clinical outcomes, survivorship and revision rates with low incidence of complications, as the conventional length or other types of short femoral components. Some concerns regarding the incidence of stress shielding phenomenon and coronal stem malalignment have been raised, requiring further evaluation through long-term studies.


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Author Biographies

I. Tatani

Department of Orthopaedic Surgery and Traumatology, Patras University Hospital, Greece

K. Solou

Department of Orthopaedic Surgery and Traumatology, Patras University Hospital, Greece

P. Megas

Department of Orthopaedic Surgery and Traumatology, Patras University Hospital, Greece


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