Mid- to long-term clinical and radiological assessment of a short, titanium, porous plasma-splayed flat-tapered cementless femoral stem: An 8-to 12-year follow-up study

Introduction: Short cementless stems offer advantages such as bone-stock preservation and minimally invasive insertion. Despite encouraging short- to midterm outcomes, the long-term clinical and radiological implications of short, titanium, and porous plasma-sprayed flat-tapered stems remain unclear. Materials and methods: A retrospective review of 138 primary total hip arthroplasties, conducted between 2010 and 2015 in 130 patients, with a minimum 8-year follow-up was performed. Patients with Dorr type A or B femora were included. Clinical and radiographic results, complications, and survival rates were evaluated. Results: A total of 102 hips (94 patients) were reviewed with complete clinical and radiographic data at a minimum 8-year follow-up (mean, 9.5 years). The modified Harris hip score significantly improved from a mean preoperative value of 40.1 to 97.8 at the final follow-up, with 91% of the hips achieving a score of >= 90. In the original cohort of 138 hips, none underwent revision surgery for symptomatic loosening. Perioperative complications occurred in eight hips, including femoral fractures, postoperative dislocation, subcutaneous abscess, and transient thigh pain. Radiographically, femoral stem alignment was predominantly neutral in 86% of the hips in the anteroposterior plane. No hip exhibited radiolucency > 1 mm, and no subsidence > 2 mm was observed. Bone ingrowth fixation was observed in all 102 hips. Stress shielding around or below the lesser trochanter occurred in 58% of hips. Kaplan-Meier survival analysis indicated a 100% survival rate at eight, 10, and 12 years for stem revision or radiological instability. Conclusions: The short, titanium, porous, plasma-sprayed, flat-tapered cementless stem exhibited excellent mid- to long-term results in primary total hip arthroplasties with Dorr type A or B femora, comparable with those of other short cementless and standard-length stems. Noteworthy survivorship was observed; however, caution is advised regarding stress-shielding complications, particularly periprosthetic femoral fractures, during extended follow-up.