The short-stem prosthesis has established itself in recent years as an innovative and bone-conserving alternative to conventional standard stems. Nevertheless, as with any hip prosthesis, the stem may need to be replaced over time. The reasons for this range from mechanical loosening and infection to material wear. This article highlights the specific advantages of the short-stem prosthesis in the context of revision surgery and how it can contribute to making the procedure less invasive and more likely to succeed.



Why is a short stem prosthesis being revised?

1. Mechanical loosening

One of the most common reasons for a stem replacement is loosening of the prosthesis, which can be caused by insufficient osseointegration or by the abrasion of material particles.

2. Infections

Postoperative infections, both acute and chronic, may necessitate replacement of the entire prosthetic system. Removal of the stem plays a central role in this process.

3. Periprosthetic fractures

Bone fractures in the area of ​​the prosthesis occur primarily in older patients with osteoporotic bone and often necessitate revision surgery.

4. Material wear and osteolysis

Modern materials such as ceramics and highly cross-linked polyethylene minimize the risk of material abrasion, but even here, abrasion particles can cause osteolysis over many years of use.

Advantages of short stem prostheses during revision

1. bone protection

Short-stem prostheses are designed to preserve as much femoral bone as possible. This is a crucial advantage if revision surgery becomes necessary, as more natural bone is available for anchoring the new prosthesis.

2. Easy removal

Due to their shorter length and minimally invasive design, short-stem prostheses are often easier to remove than standard stems. This reduces the risk of periprosthetic fractures or bone loss during the procedure.

3. Flexibility in reimplantation

After removal of the short-stem prosthesis, several options are available for reimplantation, including another short-stem prosthesis or, in cases of more severe damage, a standard stem. This versatility is particularly advantageous in complex revisions.

4. Preservation of soft tissues

Since short-stem prostheses are usually implanted via minimally invasive approaches, the surrounding muscles and soft tissues are less damaged. This also facilitates revision surgery, as there are fewer adhesions or tissue damages.

Short-stem prostheses offer several specific advantages when a stem exchange is necessary during hip revision surgery. These advantages stem from their unique design and the way they interact with the surrounding bone:

1. Preservation of the femur bone

The short-stem prosthesis requires less bone removal in the proximal femur during the initial implantation. This bone preservation becomes an advantage in the event of a stem revision:

• The replacement procedure is less invasive because more healthy bone is already present.
• Often, enough bone mass remains to use a standard prosthesis instead of a more complex revision prosthesis.

2. Simplified options for revision

Unlike longer stem prostheses, which often require a revision prosthesis with an extended stem, short stem prostheses allow for conversion to a standard prosthesis in many cases. This minimizes:

• The technical effort required for the operation.
• The risks of complications such as shaft loosening or fractures of the distal femur.

3. Less trauma and faster rehabilitation

Replacing a short stem prosthesis is generally less traumatic for the patient:

• The smaller dimensions and position of the stem in the proximal femur mean fewer surgical challenges.
• Patients benefit from a shorter surgery time, less blood loss, and a potentially faster postoperative recovery.

4. Flexibility in choosing the new prosthesis

Because the short-stem prosthesis is anchored less deeply in the femur, the distal femur usually remains intact. This offers the surgeon more flexibility in choosing the new prosthesis type and often avoids the need for a modular or extra-long revision prosthesis.

5. Minimizing subsequent complications

Long-stem prostheses carry a higher risk of complications such as distal femur fractures, especially in older patients with osteoporosis. This risk is often eliminated with short-stem prostheses, as the procedure remains in the upper part of the thigh.

The procedure for a revision of short stem prostheses

1. Preoperative planning

Before the revision surgery, a precise analysis of the bone and the existing prosthesis is performed using modern imaging techniques such as X-rays, CT scans, and MRI. This helps to create the optimal plan for removal and reimplantation.

2. Removal of the old prosthesis

Removing a short stem is generally easier and faster than removing a standard stem. This is due to the shallower anchoring depth and the bone-sparing fixation.

3. Implantation of the new prosthesis

Depending on the condition of the bone, a decision is made as to whether a short stem, a standard stem, or a modular system will be used. The goal is to achieve the best possible stability and functionality.

4. Postoperative aftercare

Rehabilitation focuses on restoring mobility and muscle strength. Patients with short-stem prostheses often benefit from a faster recovery.

Current research on the revision of short stem prostheses

Modern studies show that short-stem prostheses not only cause less bone loss during revisions, but also offer a similarly high success rate to standard stems. Young patients, in particular, benefit from this bone-preserving strategy, as they may require multiple revisions throughout their lives.

Furthermore, some studies emphasize that short stems can achieve similar mechanical stability to long stems in revisions, provided the bone status allows it.

Critical analysis: When is a short-stem prosthesis unsuitable?

Despite the many advantages, there are situations in which short stem prostheses are not ideal for revisions:

• Severe osteolysis: If the bone is severely damaged, a long shaft often offers better stability.
• Periprosthetic fractures: Here, a long stem is required to provide sufficient support for the bone.
• Chronic infections: In cases of extensive infections, modular or long shaft systems may be the better choice.

Are short-stem prostheses the future of revision surgery?

The short-stem prosthesis offers numerous advantages in the context of stem revisions, particularly with regard to bone preservation and simpler revision procedures. It is especially suitable for younger, active patients who may require further revisions during their lifetime.

However, their use requires careful preoperative planning and is not suitable in all cases. With further advances in prosthetic technology and more long-term studies, short-stem prostheses could play an even greater role in revision surgery in the future.

Conclusion: Do short-stem prostheses simplify stem replacement?

Short-stem prostheses offer significant advantages in the context of stem revision, not only through bone preservation but also through flexibility in the choice of revision strategy. The possibility of frequently reverting to a standard prosthesis and the reduced burden on the patient make short-stem prostheses a superior option in modern endoprosthetics.