# Does the use of shortened stems reduce early femoral complications in total hip arthroplasty using the direct anterior approach?

## TL;DR

This study found that shortened femoral stems in hip replacement surgery using a specific approach led to fewer early femoral complications compared to standard stems.

## Contribution

The study provides new evidence that shortened stems reduce early femoral complications in direct anterior approach hip surgery.

## Key findings

- Shortened stems had a significantly lower rate of femoral complications (1.4% vs. 5.5%) compared to standard stems.
- Shortened stems showed fewer greater trochanter (GT) fractures compared to standard stems.
- Despite more varus positioning with shortened stems, complication rates remained low.

## Abstract

The choice of femoral stem design during total hip arthroplasty (THA) through the Direct Anterior Approach (DAA) is critical. Shortened stems offer potential benefits such as bone preservation and reduced stress shielding. This study aimed to compare early complications at one year of follow-up between shortened and standard stems in DAA THA.

A retrospective monocentric case–control study included patients undergoing DAA THA from 2013 to 2023. Two cohorts were analyzed: 537 THA with standard stems and 346 THA with shortened stems. Three hundred forty-three patients in each group were matched (1:1) based on age, sex, and Body Mass Index (BMI). Two independent observers assessed femoral complications at one year. Femoral stem positioning was measured.

The mean follow-up was 12 ± 0.5 months. The mean age was 64.1 ± 11.7 years. The mean BMI was 26.4 ± 4.4 kg/m2. Shortened stems showed a significantly lower rate of femoral complications (1.4% vs. 5.5%, P = 0.005), particularly for the GT fractures (P = 0.006). In the shortened group, stem alignment was neutral in 69% of cases, varus in 27%, and valgus in 4%.

Shortened stems in DAA THA were associated with a lower rate of femoral complications, particularly fewer GT fractures. Although shortened stems were more often positioned in varus, this did not impact short-term complication rates.

The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 (Study ID 15–430).

Video Abstract

Video Abstract

The online version contains supplementary material available at 10.1186/s42836-025-00317-y.