Comparison of 5-year postoperative results between standard-length stems and short stems in one-stage bilateral total hip arthroplasty: a randomized controlled trial

Eur J Orthop Surg Traumatol. 2021 May;31(4):743-753. doi: 10.1007/s00590-020-02828-7. Epub 2020 Nov 10.


Purpose: Short stems have recently become popular in total hip arthroplasty. Previous studies aimed at elucidating the efficacy of short stems did not eliminate the influence of other factors aside from stem length. This study aimed to evaluate the usefulness of short stems compared with that of standard-length stems that have the same proximal morphology, surface coating, and material.

Methods: This was a prospective randomized study comparing 5-year midterm outcomes in 29 patients who underwent one-stage bilateral total hip arthroplasty with short and standard-length stems inserted in each of the two femurs. Clinical, radiographical, and dual-energy X-ray absorptiometry outcomes were compared.

Results: No significant differences were found in perioperative and radiographic characteristics (femoral neck anteversion, flare index, operation sequence, operation side, operation time, stem anteversion, and stem alignment). The number of joints with complications, appearance of radiopaque lines around the stems, or bone mineral density changed in stem regions 5 years postoperatively. However, greater micromotion of the stem was seen on the side of the short stem. Satisfactory improvement in hip function was seen on both sides.

Conclusion: Based on the 5-year midterm outcomes, both stems obtained satisfactory clinical outcomes despite the greater micromotion with short stems. Both stems attained bone ingrowth fixation. Moreover, the stems were not significantly different in terms of stress shielding; however, further long-term studies (> 5 years) are required to validate our findings related to stress shielding.

Keywords: Bone mineral density; Dual-energy X-ray absorptiometry; Micromotion; Stem length; Stress shielding.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Arthroplasty, Replacement, Hip* / adverse effects
  • Bone Density
  • Femur / surgery
  • Hip Prosthesis*
  • Humans
  • Prospective Studies
  • Prosthesis Design