Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis

Abstract

Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/ implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.

Early Clinical and Radiographic Outcomes of Total Hip Arthroplasty with DELTA ST-C Cup and MINIMA S Stem

“…Femoral cementless fixation in THA has been proven clinically and radiologically to have excellent long-term results [ 9 ]. Considering that more THAs are performed in younger and more active individuals, over the last two decades, a new total hip replacement philosophy, called “tissue sparing surgery”, has become more popular [ 9 , 10 ].…”

“…Femoral cementless fixation in THA has been proven clinically and radiologically to have excellent long-term results [ 9 ]. Considering that more THAs are performed in younger and more active individuals, over the last two decades, a new total hip replacement philosophy, called “tissue sparing surgery”, has become more popular [ 9 , 10 ]. The principles consist of reduced bone and soft tissue aggression; therefore, new conservative short femoral prostheses have been designed as alternatives to conventional stems.…”

How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery

“…Total hip arthroplasty (THA) is one of the most effective treatments for hip joint disease, resulting in increased range of motion (ROM), pain management, and improved quality of life in most cases [1]. Over time, the development of hip joint replacement models has been the catalyst for significant improvements in both implantation methods and materials [2,3]. These include the latest bearing surfaces with larger femoral head sizes, which are designed to reduce bearing wear and the risk of dislocation while increasing the range of motion in the hip [2,4].…”

“…Over time, the development of hip joint replacement models has been the catalyst for significant improvements in both implantation methods and materials [2,3]. These include the latest bearing surfaces with larger femoral head sizes, which are designed to reduce bearing wear and the risk of dislocation while increasing the range of motion in the hip [2,4]. However, failed total hip replacements (THRs) requiring revision surgery remain an important issue and are expected to increase in the coming years [5,6].…”