A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register


  • Mirthe H W van Veghel Department of Orthopedics, Radboud University Medical Center, Nijmegen https://orcid.org/0000-0001-8488-957X
  • Gerjon Hannink Department of Medical Imaging, Radboud University Medical Center, Nijmegen https://orcid.org/0000-0001-9526-3775
  • Jakob van Oldenrijk Erasmus University Medical Center, Department of Orthopedics and Sport Medicine, Rotterdam
  • Liza N van Steenbergen Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), ‘s-Hertogenbosch, the Netherlands https://orcid.org/0000-0002-8141-842X
  • B Willem Schreurs Department of Orthopedics, Radboud University Medical Center, Nijmegen; Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), ‘s-Hertogenbosch, the Netherlands https://orcid.org/0000-0003-4518-431X




Arthroplasty register, Hip revision arthroplasty, LROI, Short stem, Total hip arthroplasty


Background and purpose: We aimed to compare revision rates between uncemented short and standard stems in total hip arthroplasties (THAs) and the corresponding patient-reported outcome measures (PROMs).
Patients and methods: We included all short (C.F.P., Fitmore, GTS, Metha, Nanos, Optimys, Pulchra, and Taperloc Microplasty) and standard stems in uncemented THAs registered between 2009 and 2021 in the Dutch Arthroplasty Register. Kaplan–Meier survival and multivariable Cox regression analyses were performed with overall and femoral stem revision as endpoints.
Results: Short stems were used in 3,352 and standard stems in 228,917 hips. 10-year overall revision rates (4.8%, 95% confidence interval [CI] 3.7–6.3 vs. 4.5%, CI 4.4–4.6) and femoral stem revision rates (3.0%, CI 2.2–4.2 vs. 2.3%, CI 2.2–2.4) were comparable for short- and standard-stem THAs. Today’s predominant short stems (Fitmore and Optimys) showed short-term revision rates similar to that of standard-stem THAs. Other, less frequently used short stems had higher 10-year overall (6.3%, CI 4.7–8.5) and femoral stem (4.5%, CI 3.1–6.3) revision rates. Multivariable Cox regression also showed a higher risk for overall (HR 1.7, CI 1.0–2.9) and femoral stem revision (HR 2.0, CI 1.1–3.5) using the latter short stems compared with standard stems. An exploratory analysis of PROMs showed no difference.
Conclusion: There was no overall difference in revision rates but a tendency toward increased revision of short stems both for the whole THA and for the stem itself. The less frequently used short stems had increased revision risk. No difference in PROMs was shown.



Download data is not yet available.


Mei X Y, Gong Y J, Safir O, Gross A, Kuzyk P. Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 2019; 62: 249-58. doi: 10.1503/cjs.013118. DOI: https://doi.org/10.1503/cjs.013118

Pivec R, Johnson A J, Mears S C, Mont M A. Hip arthroplasty. Lancet 2012; 380: 1768-77. doi: 10.1016/S0140-6736(12)60607-2. DOI: https://doi.org/10.1016/S0140-6736(12)60607-2

Bayliss L E, Culliford D, Monk A P, Glyn-Jones S, Prieto-Alhambra D, Judge A, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017; 389: 1424-30. doi: 10.1016/S0140-6736(17)30059-4. DOI: https://doi.org/10.1016/S0140-6736(17)30059-4

Lidder S, Epstein D J, Scott G. A systematic review of short metaphyseal loading cementless stems in hip arthroplasty. Bone Joint J 2019; 101-B: 502-11. doi: 10.1302/0301-620X.101B5.BJJ-2018-1199.R1. DOI: https://doi.org/10.1302/0301-620X.101B5.BJJ-2018-1199.R1

Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics 2015; 38: S6-13. doi: 10.3928/01477447-20150215-50. DOI: https://doi.org/10.3928/01477447-20150215-50

Khanuja H S, Banerjee S, Jain D, Pivec R, Mont M A. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014; 96: 1742-52. doi: 10.2106/JBJS.M.00780. DOI: https://doi.org/10.2106/JBJS.M.00780

Gustke K. Short stems for total hip arthroplasty: initial experience with the Fitmore stem. J Bone Joint Surg Br 2012; 94: 47-51. doi: 10.1302/0301-620X.94B11.30677. DOI: https://doi.org/10.1302/0301-620X.94B11.30677

van Oldenrijk J, Molleman J, Klaver M, Poolman R W, Haverkamp D. Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop 2014; 85: 250-8. doi: 10.3109/17453674.2014.908343. DOI: https://doi.org/10.3109/17453674.2014.908343

Patel R M, Stulberg S D. The rationale for short uncemented stems in total hip arthroplasty. Orthop Clin North Am 2014; 45: 19-31. doi: 10.1016/j.ocl.2013.08.007. DOI: https://doi.org/10.1016/j.ocl.2013.08.007

Hauer G, Vielgut I, Amerstorfer F, Maurer-Ertl W, Leithner A, Sadoghi P. Survival rate of short-stem hip prostheses: a comparative analysis of clinical studies and national arthroplasty registers. J Arthroplasty 2018; 33: 1800-5. doi: 10.1016/j.arth.2018.01.017. DOI: https://doi.org/10.1016/j.arth.2018.01.017

Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short stems versus conventional stems in cementless total hip arthroplasty: a long-term registry study. J Arthroplasty 2018; 33: 1794-9. doi: 10.1016/j.arth.2018.01.005. DOI: https://doi.org/10.1016/j.arth.2018.01.005

van Steenbergen L N, Denissen G A, Spooren A, van Rooden S M, van Oosterhout F J, Morrenhof J W, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86: 498-505. doi: 10.3109/17453674.2015.1028307. DOI: https://doi.org/10.3109/17453674.2015.1028307

LROI. Annual report 2022. Landelijke Registratie Orthopedische Interventies; 2022. Available from: https://www.lroi-report.nl/.

Feyen H, Shimmin A J. Is the length of the femoral component important in primary total hip replacement? Bone Joint J 2014; 96-B: 442-8. doi: 10.1302/0301-620X.96B4.33036. DOI: https://doi.org/10.1302/0301-620X.96B4.33036

Pardo F, Bordini B, Castagnini F, Giardina F, Faldini C, Traina F. Are powder-technology-built stems safe? A midterm follow-up registry study. J Mater Sci Mater Med 2021; 32: 10. doi: 10.1007/s10856-020-06481-8. DOI: https://doi.org/10.1007/s10856-020-06481-8

Erivan R, Villatte G, Dartus J, Mertl P, Piriou P, Tracol P, et al. French Hip & Knee Society classification of short-stem hip prostheses: inter- and intra-observer reproducibility. Orthop Traumatol Surg Res 2022; 108: 103126. doi: 10.1016/j.otsr.2021.103126. DOI: https://doi.org/10.1016/j.otsr.2021.103126

LROI. LROI Implant Library — Hip. Landelijke Registratie Orthopedische Interventies; 2022. Available from: https://golive3.gopublic.nl/media/www.lroi.nl/2022/04/625522c726f17.lroi-implant-library-hip.pdf.

Schemper M, Wakounig S, Heinze G. The estimation of average hazard ratios by weighted Cox regression. Stat Med 2009; 28: 2473-89. doi: 10.1002/sim.3623. DOI: https://doi.org/10.1002/sim.3623

Steinbrück A, Grimberg A W, Elliott J, Melsheimer O, Jansson V. Short versus conventional stem in cementless total hip arthroplasty: an evidence-based approach with registry data of mid-term survival. Orthopade 2021; 50: 296-305. doi: 10.1007/s00132-021-04083-y. DOI: https://doi.org/10.1007/s00132-021-04083-y

AOANJRR. Hip, knee & shoulder arthroplasty: 2021 annual report. Australian Orthopaedic Association National Joint Replacement Registry; 2021. Available from: https://aoanjrr.sahmri.com/annual-reports-2021.

Zijlstra W P, De Hartog B, Van Steenbergen L N, Scheurs B W, Nelissen R. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. Acta Orthop 2017; 88: 395-401. doi: 10.1080/17453674.2017.1317515. DOI: https://doi.org/10.1080/17453674.2017.1317515

Zhu Y, Zhang F, Chen W, Liu S, Zhang Q, Zhang Y. Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 2015; 89: 82-9. doi: 10.1016/j.jhin.2014.10.008. DOI: https://doi.org/10.1016/j.jhin.2014.10.008

Hutchings A, Neuburger J, Grosse Frie K, Black N, van der Meulen J. Factors associated with non-response in routine use of patient reported outcome measures after elective surgery in England. Health Qual Life Outcomes 2012; 10: 34. doi: 10.1186/1477-7525-10-34. DOI: https://doi.org/10.1186/1477-7525-10-34

EPRD. Annual Report 2021. The German Arthroplasty Registry (EPRD); 2021. Available from: https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/AnnualReport2021-Web_2022-05-19_F.pdf.



How to Cite

van Veghel, M. H. W., Hannink, G., van Oldenrijk, J., van Steenbergen, L. N., & Schreurs, B. W. (2023). A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register. Acta Orthopaedica, 94, 330–335. https://doi.org/10.2340/17453674.2023.13652





Most read articles by the same author(s)

1 2 3 4 > >>