A short stem solution: through small portals.

Abstract

While short stem design in total hip arthroplasty (THA) is not a new concept, interest has surged with the increasing popularity of less invasive techniques. Given the success of traditional stems, why consider short stems? Several reasons exist. If the goal of the tapered stem is to load preferentially proximally, achieve tight fit, and deliver stresses into proximal bone, do we need a stem at all? While long stems may prevent varus malalignment, varus malalignment of tapers does not impair results. Short stems are easier to insert, especially when using an anterior approach. Femoral preparation is accomplished with straightforward broaching without reamers. Short stems are bone conserving, violating less bone stock and providing more favorable conditions should revision be required. As with any novel device, longer follow-up is needed to fully assess shortened tapered stems. However, our early results in 640 primary THAs at up to 38 months are promising. Usually 1 or 2 diameter sizes larger are required with the short vs standard length version of the same tapered design. Be aggressive with sizing, pushing to the largest possible. Use the broach like a rasp. Drive the component in valgus during insertion. Upon seating, do a trial reduction using the shortest available neck length. The component generally sits slightly prouder than the broach and may require additional effort to seat completely.