Ultra-Short Cementless Hip Stems Show Excellent 12-Year Durability for Primary Hip Arthroplasty, suggests study
A recent retrospective case series published in the Indian Journal of Orthopaedics in December 2025 reveals a remarkable 93.7% survivorship at 12.1 years for ultra-short cementless stems, offering a highly effective, bone-preserving solution for primary hip arthroplasty in younger patients.
Cementless total hip arthroplasty (THA) is preferred for younger patients, but subsequent revisions are often complicated by bone density loss. While tissue-preserving ultra-short stems (USS) help conserve bone, clinical concerns persist regarding their risk of mechanical loosening. To address this, Tapasvi et al. evaluated the long-term osseointegration and clinical durability of the Proxima USS in a younger, active patient population.
Therefore, the retrospective case series evaluated 32 primary total hip arthroplasties in 26 patients (≤70 years) with end-stage coxarthrosis over a mean 12.1-year follow-up. Clinical outcomes were measured using Kaplan-Meier stem survivorship and the Harris Hip Score (HHS), excluding patients with hip dysplasia, acquired deformities, or less than 10 years of follow-up.
Key Clinical Findings of the Study Includes:
Functional Recovery: The investigation demonstrated a statistically significant functional enhancement, with the mean HHS impressively improving by 39.3 points from preoperative levels to reach an outstanding 87.8 at the 10-year postoperative mark.
Long-term Survivorship: The analysis recorded a highly robust overall stem survivorship of 93.7% at final follow-up, with only two out of the 32 stems ever requiring surgical revision due to a late hematogenous infection and an adverse metal reaction.
Radiographic Integration: The review confirmed excellent and durable osseointegration, detailing that 29 of the 30 unrevised stems proudly exhibited Grade A stable bone ingrowth without any observable radiolucent lines across the examined Gruen zones.
Precision Alignment: The study importantly highlighted that 100% of the placed implants successfully achieved optimal coronal and sagittal metaphyseal fill, while 94% properly maintained a neutral axial alignment without any concerning degrees of implant mispositioning.
The results suggest that the Proxima cementless ultra-short stem is an extraordinarily durable and mechanically effective implant, seamlessly maintaining a remarkable 93.7% survivorship over an extended 12.1-year evaluation period.
Thus, the study concludes clinicians might beneficially consider utilizing ultra-short stem designs primarily in patients presenting with robust Dorr type A and B femoral bone structures where preserving diaphyseal bone is a top priority, while gently avoiding their use in poor-quality Dorr type C bone to safely ensure optimal long-term fixation.
The findings are naturally limited by a relatively small, highly selective cohort of compliant younger patients managed exclusively by a single highly experienced surgeon. Future randomized multicenter trials comparing these ultra-short designs with traditional diaphyseal-engaging stems might gently enhance our comprehensive understanding of these favorable clinical outcomes.
Reference
Tapasvi, S. R., Chowdhry, M., Shekhar, A., Tapasvi, K. S., Browne, J. A., & McPherson, E. J. (2025). Results of an Ultra Short Metaphyseal Filling Cementless Stem in Primary Total Hip Arthroplasty: Mean 12.1-Year Follow-up. Indian Journal of Orthopaedics.
