What are the optimal stem selection criteria for total hip arthroplasty (THA)?

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From the Guidelines

The use of a cemented femoral stem is recommended for hip arthroplasty, as evidenced by strong strength of evidence and strong strength recommendation. When selecting the optimal stem for hip arthroplasty, several factors should be considered, including patient age, bone quality, anatomy, and activity level.

  • Key considerations include:
    • Patient age and bone quality: cemented stems may be more suitable for elderly patients with osteoporotic bone, as they provide more reliable initial fixation 1.
    • Femoral canal morphology: the stem design should match the patient's femoral canal morphology, with straight stems for Dorr type A (champagne flute) femurs and tapered designs for Dorr type C (stovepipe) femurs.
    • Preservation of bone stock: short stems may be appropriate for younger patients to preserve bone stock for potential future revisions.
    • Restoration of native femoral offset: the stem offset should restore the patient's native femoral offset to optimize abductor function and joint stability.
    • Surgeon familiarity: the surgeon's familiarity with specific implant systems should also influence selection, as technical expertise with a particular system often yields better outcomes than using an unfamiliar "optimal" implant.
  • Additionally, preoperative templating is essential to determine appropriate stem size and position, and modular stems can address complex anatomy but carry risks of corrosion at modular junctions.
  • Overall, the selection of the optimal stem for hip arthroplasty should prioritize the use of cemented femoral stems, as recommended by the strongest and most recent evidence 1.

From the Research

Optimal Stem Selection for Hip Arthroplasty

When selecting an optimal stem for hip arthroplasty, several factors must be considered, including the type of hip dysplasia, the patient's age and activity level, and the surgical approach.

  • The study by 2 found that a flat tapered wedge short femoral stem can provide favorable clinical functional outcomes and biological fixation in patients with hip dysplasia.
  • Another study by 3 found that a cementless tapered femoral stem can provide significant improvement in function and stable implant fixation in patients with acute femoral neck fractures.
  • The study by 4 found that a taper-wedge stem with a morphometric design and size-specific medial curvature can provide excellent clinical outcomes and low complication rates in patients undergoing total hip arthroplasty via the direct anterior approach.

Stem Design and Materials

The design and materials of the stem can also impact the outcome of hip arthroplasty.

  • The study by 5 found that the use of a titanium-molybdenum-zirconium-iron alloy stem with a cobalt-chrome-molybdenum head can lead to adverse reactions to metal debris and corrosion at the taper-trunnion junction.
  • The study by 6 found that the use of a titanium ingrowth prosthesis and bone grafting can provide good clinical outcomes and low complication rates in patients undergoing revision total hip arthroplasty for failed cemented femoral component loosening.

Surgical Approach and Technique

The surgical approach and technique can also impact the outcome of hip arthroplasty.

  • The study by 4 found that the direct anterior approach can provide excellent clinical outcomes and low complication rates when used with a taper-wedge stem.
  • The study by 2 found that the use of a flat tapered wedge short femoral stem can provide favorable clinical functional outcomes and biological fixation in patients with hip dysplasia, regardless of the surgical approach.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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