# The influence of stem length on perioperative complications following cemented hip arthroplasty in metastatic femoral disease: A systematic review

## TL;DR

This study finds that using long stems in hip surgery for bone cancer increases complications, suggesting shorter stems may be safer.

## Contribution

First systematic review comparing complication rates of different stem lengths in hip arthroplasty for femoral metastases.

## Key findings

- Long stems had 26.0% vs. 3.1% higher cardiopulmonary complications than short/standard stems.
- Total complication rates were 28.8% for long stems versus 10.6% for shorter stems.
- Only 1.3% of cases showed new distal metastatic lesions.

## Abstract

Long stem cemented hip arthroplasty remains a common surgical treatment for metastatic disease to the proximal femur. However, long stems may increase the risk of cardiopulmonary complications due to embolic events. This study presents the first systematic review directly comparing perioperative complication rates between long and short/standard cemented femoral stems in this patient population.

A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library was conducted in accordance with PRISMA guidelines. Studies were included if they reported on cemented hip arthroplasty for proximal femoral metastases, defined femoral stem length (short/standard: <250 mm vs. long: ≥250 mm), and described perioperative cardiopulmonary complications.

Seven studies met inclusion criteria, encompassing 379 femurs (160 short/standard stems and 219 long stems). Patients who received long-stem constructs had significantly higher rates of total perioperative cardiopulmonary complications (26.0 % vs. 3.1 %). Total complication rates were also higher in the long-stem group (28.8 % vs. 10.6 %). Only five cases (1.3 %) of new distal metastatic lesions were reported.

Long cemented femoral stems are associated with higher perioperative complication rates than short or standard stems in patients undergoing hip arthroplasty for proximal femoral metastases. Given the low observed incidence of new distal lesions, the rationale for routinely using long stems warrants reconsideration. Future prospective studies should adopt standardized definitions for cardiopulmonary complications and stem length, report BCIS using validated criteria, and evaluate the true incidence of new distal metastases to guide surgical decision-making in this high-risk population.

•First systematic review to compare complication rates between differing stem lengths in proximal femoral metastases.•Long cemented stems were associated with higher rates of cardiopulmonary complications compared to shorter length stems.•Findings may guide surgical decision-making by balancing fixation goals with perioperative risk profiles.

First systematic review to compare complication rates between differing stem lengths in proximal femoral metastases.

Long cemented stems were associated with higher rates of cardiopulmonary complications compared to shorter length stems.

Findings may guide surgical decision-making by balancing fixation goals with perioperative risk profiles.