The short-stem hip prosthesis has established itself in recent decades as an innovative alternative to the classic straight-stem prosthesis. Thanks to its gentle anchoring in the proximal femoral structures and the use of modern materials and bearing surfaces, a short-stem prosthesis can offer impressively long-lasting results with uncomplicated healing. But what does this mean specifically for patients, and what factors influence the lifespan of a short-stem prosthesis?

In this article, we examine the durability of the short stem prosthesis in detail and focus in particular on modern bearing surfaces that have significantly reduced wear.

What is a short-stem prosthesis?

A short-stem hip prosthesis is an artificial replacement for the hip joint, characterized by a shorter stem compared to a traditional hip prosthesis. It is used particularly in younger and active patients because it:

• Promotes bone preservation: Less bone needs to be removed during surgery.
• A physiological load is permitted: The shaft is anchored in the dense, load-bearing bone areas of the femur.
• It is easier to switch: In the event of a revision, more bone material is preserved for subsequent therapy.

Durability of short-stem hip prostheses

Factors that affect lifespan

The durability of a short stem prosthesis is influenced by several factors:

1. Materials and sliding pairings

• Advanced materials such as ceramic-ceramic or ceramic-polyethylene bearing pairs reduce abrasion and prevent long-term loosening.

1. Anchoring technology

• Short stem prostheses are usually cementless, which allows for bone ingrowth.

1. Surgical method

• Gentle surgical techniques and precise placement reduce the risk of complications.

1. Patient factors

• Age, bone density and activity level play a role in the stress placed on the prosthesis.

Modern bearing surfaces: A revolution in endoprosthetics

Bearing surfaces are the surfaces that meet in the hip joint and enable movement. Several modern combinations are available today:

• Ceramic on ceramic: Excellent biocompatibility and minimal abrasion.
• Ceramic on highly cross-linked polyethylene (XPE): Combines durability with better shock absorption compared to purely ceramic combinations.
• Metal on polyethylene: Now replaced by ceramic options to avoid metal abrasion.

The low wear rate of modern bearing surfaces prevents the formation of particles that can cause inflammation and bone loss (osteolysis). This significantly reduces the risk of long-term loosening. A revision surgery, for example after 15-20 years, is therefore highly unlikely today.

How long does a short-stem hip prosthesis last?

Long-term results from clinical trials

Clinical data and case reports show that short-stem prostheses may offer similar, if not better, long-term results than classic straight-stem prostheses:

• Studies indicate that approximately are still functional after 10 years
• Modern bearing surfaces and optimized implant designs lead experts to believe that, with uncomplicated healing of such short-stem prostheses, a lifespan of 40 to 50 years may be realistic.

Revisions and exchange operations

• In rare cases, implants may need to be replaced due to infections, fractures, or loosening.
• Revision is easier with short-stem prostheses due to the shorter stem and the bone-sparing approach.

Advantages of short-stem prostheses for long-term use

Bone preservation

Short-stem prostheses require less extensive resections, thus preserving the femur as much as possible. This is a crucial advantage, especially in revision surgeries.

More natural biomechanics

Anchoring in the proximal area of ​​the femur ensures a more physiological load distribution, which makes the prosthesis more stable in the long term.

Longer lifespan through bony integration

In cementless short stem prostheses, successful bony integration leads to a firm anchorage that is maintained for decades.

Conclusion

The short-stem prosthesis is a forward-looking approach in hip arthroplasty. With modern materials and optimized fixation techniques, it has the potential to last for many decades. Thanks to low wear and biomechanically advantageous integration, patients can benefit from a prosthesis that not only alleviates pain but also enables near-normal mobility. Study results and clinical experience suggest that short-stem prostheses could now achieve a lifespan of up to 50 years in many cases – provided that the healing process is uncomplicated and the patient adheres to recommended weight-bearing guidelines.

Feel free to consult with Prof. Kutzner at the ENDOPROTHETICUM.