International Orthopaedics

, Volume 43, Issue 1, pp 55–61 | Cite as

Fourteen-year experience with short cemented stems in total hip replacement

  • Nicola SantoriEmail author
  • Francesco Falez
  • Domenico Potestio
  • Francesco Saverio Santori
Original Paper



The age of the population requiring total hip replacement (THR) is increasing and this may lead to a return of cemented stems. Advantages of a short cemented femoral device include preservation of metaphyseal bone, easier insertion, and easier cement removal in case of revision. The purpose of this study is to describe the rationale and assess midterm results of unique innovative short cemented double-tapered polished stem applied with contemporary cementing techniques.


Our experience with this short cemented stem includes two different groups of elderly patients. Group 1 (prototype version of the short stem) from January 2005 to January 2008 counts 43 THR. Group 2 (final commercial version of the short stem) from January 2013 to January 2015 counts 54 THR. The average age in groups 1 and 2 was 79 and 75 respectively. Patients underwent clinical follow-up with the Harris Hip Score (HHS) and completed radiographic evaluation.


Thirty-one patients of group 1 had died for reasons unrelated to their THR. The surviving 9 hips have a follow-up of 11.2 years. In group 2, eight  patients died for reasons unrelated to their THR. Follow-up for the surviving 40 patients is 4.6 years. HHS improved in both groups. In 34/43 hips of group 1 and in 41/54 of group 2 we observed a Barrack grade A cement mantle. Survival with revision of the stem for aseptic loosening as the endpoint was 100%.


This study confirms the effectiveness of a short, polished, collarless, tapered cemented stem implanted with contemporary cementing techniques which appears as successful as the standard sized components.


Short stem Cemented THR Aging population Osteoporosis Exeter philosophy 


Compliance with ethical standards

Conflict of interest

Author Francesco Falez receives royalties from LimaCorporate Company.

Author Francesco Saverio Santori receives royalties from LimaCorporate Company.


  1. 1.
    Lombardi AV Jr, Berend KR, Mallory TH, Skeels MD, Adams JB (2009) Survivorship of 2000 tapered titanium porous plasma-sprayed femoral components. Clin Orthop Relat Res 467(1):146–154CrossRefGoogle Scholar
  2. 2.
    Wyatt M, Hooper G, Frampton C, Rothwell A (2016) Survival outcomes of cemented compared to uncemented stems in primary total hip replacement. World J Orthod 5(5):591–596CrossRefGoogle Scholar
  3. 3.
    Ogino D, Kawaji H, Konttinen L et al (2008) Total hip replacement in patients eighty years of age and older. J Bone Joint Surg A 90(9):1884–1890CrossRefGoogle Scholar
  4. 4.
    Maier GS, Kolbow K, Lazovic D, Maus U (2016) The importance of bone mineral density in hip arthroplasty: results of a survey asking orthopaedic surgeons about their opinions and attitudes concerning osteoporosis and hip arthroplasty. Adv Orthop 2016:8079354. CrossRefGoogle Scholar
  5. 5.
    Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374(9696):1196–1208CrossRefGoogle Scholar
  6. 6.
    Jämsen E, Eskelinen A, Peltola M, Mäkelä K (2014) High early failure rate after cementless hip replacement in the octogenarian. Clin Orthop Relat Res 472:2779–2789CrossRefGoogle Scholar
  7. 7.
    Parvizi J, Holiday AD, Ereth MH, Lewallen DG (1999) The Frank Stinchfield award. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res (369):39–48Google Scholar
  8. 8.
    Augustin L, Boller S, Bobach C, Jahnke A, Ahmed GA, Rickert M, Ishaque BA (2018) Development of periprosthetic bone mass density around the cementless Metha® short hip stem during three year follow up-a prospective radiological and clinical study. Int Orthop.
  9. 9.
    Miladi M, Villain B, Mebtouche N, Bégué T, Aurégan JC (2018) Interest of short implants in hip arthroplasty for osteonecrosis of the femoral head: comparative study “uncemented short” vs “cemented conventional” femoral stems. Int Orthop 42(7):1669–1674Google Scholar
  10. 10.
    Merschin D, Häne R, Tohidnezhad M, Pufe T, Drescher W (2018) Bone-preserving total hip arthroplasty in avascular necrosis of the hip-a matched-pairs analysis. Int Orthop 42(7):1509–1516CrossRefGoogle Scholar
  11. 11.
    Yan SG, Weber P, Steinbrück A, Hua X, Jansson V, Schmidutz F (2018) Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. Int Orthop 42(9):2077–2086CrossRefGoogle Scholar
  12. 12.
    Cho YJ, Bae CI, Yoon WK, Chun YS, Rhyu KH (2018) High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem. Int Orthop 42(2):303–309CrossRefGoogle Scholar
  13. 13.
    Yan SG, Woiczinski M, Schmidutz TF, Weber P, Paulus AC, Steinbrück A, Jansson V, Schmidutz F (2017) Can the metaphyseal anchored Metha short stem safely be revised with a standard CLS stem? A biomechanical analysis. Int Orthop 41(12):2471–2477CrossRefGoogle Scholar
  14. 14.
    Sariali E, Knaffo Y (2017) Three-dimensional analysis of the proximal anterior femoral flare and torsion. Anatomic bases for metaphyseally fixed short stems design. Int Orthop 41(10):2017–2023CrossRefGoogle Scholar
  15. 15.
    Kutzner KP, Kovacevic MP, Roeder C, Rehbein P, Pfeil J (2015) Reconstruction of femoro-acetabular offsets using a short-stem. Int Orthop 39(7):1269–1275CrossRefGoogle Scholar
  16. 16.
    Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R (2017) Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. Int Orthop 41(7):1347–1353CrossRefGoogle Scholar
  17. 17.
    von Rottkay E, Rackwitz L, Rudert M, Nöth U, Reichert JC (2018) Function and activity after minimally invasive total hip arthroplasty compared to a healthy population. Int Orthop 42(2):297–302CrossRefGoogle Scholar
  18. 18.
    Santori FS, Santori N (2002) Stem position with a fourth generation cementing technique. Orthopaedic Proceedings|Volume 84-B, Issue SUPP_III|01 NovGoogle Scholar
  19. 19.
    Gie GA, Ling RS (1994) Loosening and migration of Exeter THR. J Bone Joint Surg (Br) 76(3):506–507CrossRefGoogle Scholar
  20. 20.
    Petheram TG, Whitehouse SL, Kazi HA, Hubble MJ, Timperley AJ, Wilson MJ, Howell JR (2016) The Exeter universal cemented femoral stem at 20 to 25 years: a report of 382 hips. Bone Joint J 98-B(11):1441–1449CrossRefGoogle Scholar
  21. 21.
    Santori FS, Santori N (2010) Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 92(9):1231–1237CrossRefGoogle Scholar
  22. 22.
    Marega L,Gnagni P (2016) Fourth generation cementing technique with a novel short-stem in primary total hip arthroplasty. Orthopaedic Proceedings|Volume 98-B, Issue SUPP_9|01 MayGoogle Scholar
  23. 23.
    Santori N, Potestio D, Bertino A, Santori FS (2015) Mid-term results of a short cemented femoral component. Hip Int 25(Suppl 1):S2–S59Google Scholar
  24. 24.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755CrossRefGoogle Scholar
  25. 25.
    Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17Google Scholar
  26. 26.
    Mulroy WF, Estok DM, Harris WH (1995) Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up study. J Bone Joint Surg Am 77(12):1845–1852CrossRefGoogle Scholar
  27. 27.
    Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293Google Scholar
  28. 28.
    Callaghan JJ, Rosenberg AG, Rubash HE, Clohisy JC, Beaule PE, Della Valle CJ (2016) Short-stem designs for Total hip arthroplasty: neck stabilized femoral components January. In : Wolters KluwerEditors. The adult hip “hip arthroplasty surgery” Third Edition: Chapter 64Google Scholar
  29. 29.
    Choy GG, Roe JA, Whitehouse SL, Cashman KS, Crawford RW (2013) Exeter short stems compared with standard length Exeter stems: experience from the Australian Orthopaedic Association National Joint Replacement registry. J Arthroplasty 28(1):103–109CrossRefGoogle Scholar
  30. 30.
    Kutzner KP, Freitag T, Bieger R, Reichel H, Pfeil J, Ignatius A, Dürselen L (2018) Biomechanics of a cemented short stem: standard vs. line-to-line cementation techniques. A biomechanical in-vitro study involving six osteoporotic pairs of human cadaver femurs. Clin Biomech 52:86–94CrossRefGoogle Scholar
  31. 31.
    Bishop NE, Burton A, Maheson M (2010) Biomechanics of short hip endoprostheses—the risk of bone failure increases with decreasing implant size. Clin Biomech (Bristol, Avon) 25:666–674CrossRefGoogle Scholar
  32. 32.
    Donaldson AJ, Thomson HE, Harper NJ, Kenny NW (2009) Bone cement implantation syndrome. Br J Anaesth 102:12–22CrossRefGoogle Scholar
  33. 33.
    Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ et al (2013) 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 382:1097–1104CrossRefGoogle Scholar
  34. 34.
    Costa ML, Griffin XL, Pendleton N, Pearson M, Parsons N (2011) Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database. J Bone Joint Surg Br 93:1405–1410CrossRefGoogle Scholar
  35. 35.
    Kelly AJ, Lee MB, Wong NS, Smith EJ, Learmonth ID (1996) Poor reproducibility in radiographic grading of femoral cementing technique in total hip arthroplasty. J Arthroplast 11(5):525–528CrossRefGoogle Scholar
  36. 36.
    Kim SM, Han SB, Rhyu KH, Yoo JJ, Oh KJ, Yoo JH, Lee KJ, Lim SJ (2018) Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty-a multicentric analysis. Int Orthop 42(9):2069–2076CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Nicola Santori
    • 1
    Email author
  • Francesco Falez
    • 2
  • Domenico Potestio
    • 1
  • Francesco Saverio Santori
    • 3
  1. 1.Department of Orthopaedic and Trauma SurgeryRome American HospitalRomeItaly
  2. 2.Department of Orthopaedic and Trauma SurgeryOspedale Santo SpiritoRomeItaly
  3. 3.Centro DiagnosticoRomeItaly

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