The short stem prosthesis has established itself in recent years as an innovative and bone-preserving alternative to conventional standard stems. Nevertheless, like any hip prosthesis, it can lead to a replacement of the stem over time. The reasons range from mechanical loosening to infections and material wear. This article highlights the specific advantages of the short stem prosthesis in the context of a revision and how it can contribute to making the intervention less invasive and more promising.



Why is a short stem prosthesis revised?

1. Mechanical loosening

One of the most common causes of stem replacement is loosening of the prosthesis, which can be triggered by inadequate osseointegration or abrasion of material particles.

2. Infections

Postoperative infections, both acute and chronic, may require replacement of the entire prosthetic system. The removal of the stem plays a central role in this.

3. Periprosthetic fractures

Bone fractures in the area of the prosthesis occur mainly in older patients with osteoporotic bone and often necessitate a revision.

4. Material wear and osteolysis

Modern materials such as ceramic and highly cross-linked polyethylene minimize the risk of material wear, but with long-term use, wear particles can also cause osteolysis here.

Advantages of short-stem prostheses in revision surgery

1. Bone preservation

Short stem prostheses are designed to preserve as much femoral bone as possible. This is a crucial advantage when revision is required, 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 again a 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 typically implanted through minimally invasive approaches, the surrounding muscles and soft tissues are less damaged. This also facilitates revision, as there are fewer adhesions or tissue damage.

Short stem prostheses offer several specific advantages when a stem revision is necessary as part of a hip revision. These advantages are based on their unique design and the way they interact with the surrounding bone:

1. Preservation of the femoral bone

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

• The replacement is less invasive since more healthy bone is already present.
• There is often sufficient bone mass remaining to use a standard prosthesis instead of a more complex revision prosthesis.

2. Simplified options during revision

In contrast to longer stem prostheses, which often require a revision prosthesis with an extended stem during revision, the short stem prosthesis allows for a change to a standard prosthesis in many cases. This minimizes:

• The technical complexity of the operation.
• The risks for complications such as stem loosening or fractures of the distal femur.

3. Less trauma and faster rehabilitation

The replacement of a short stem prosthesis is generally less traumatic for the patient:

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

4. Flexibility in choosing the new prosthesis

Since the short-stem prosthesis is anchored less deeply in the femur, the distal femur usually remains intact. This gives 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 femoral fractures, especially in older patients with osteoporosis. With short-stem prostheses, this risk is often eliminated because the revision remains in the upper region of the thigh.

The procedure for a revision with short stem prostheses

1. Preoperative planning

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

2. Removal of the old prosthesis

The removal of the short stem is generally simpler and faster than with standard stems. This is due to the lower anchoring depth and bone-preserving fixation.

3. Implantation of the new prosthesis

Depending on the condition of the bone, it is decided whether to use a short stem, a standard stem, or a modular system again. The goal is to achieve the best possible stability and functionality.

4. Postoperative care

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

Current studies 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 as standard stems. Particularly young patients benefit from the bone-conserving strategy, as they may require multiple revisions throughout their lives.

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

Critical consideration: When is the short stem prosthesis not suitable?

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 stem often provides better stability.
• Periprosthetic fractures: Here, a long stem is required to adequately support the bone.
• Chronic infections: In cases of extensive infections, modular or long stem systems may be a better choice.

Are short stem prostheses the future of revision?

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 particularly suitable for younger, active patients who may require further revisions during their lifetime.

However, their use requires careful preoperative planning and is not suitable for 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 revision?

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