# Cementless Short-Stem Total Hip Arthroplasty in Patients Aged 75 Years and Older: A Retrospective Single-Surgeon Study

## TL;DR

This study shows that cementless short-stem hip implants work well in elderly patients, with low complication rates and good outcomes.

## Contribution

Demonstrates safety and effectiveness of cementless short-stem THA in elderly patients, challenging prior concerns about implant stability.

## Key findings

- Implant survival rate was 98% with no aseptic loosening cases.
- Complication rate was 3.3%, including three revisions and one dislocation.
- Outcomes were comparable to younger patient groups despite older age.

## Abstract

Introduction

Cementless short-stem total hip arthroplasty (THA) has gained popularity due to its bone-preserving potential and favorable biomechanical properties. However, its use in elderly patients remains controversial due to concerns about bone quality and implant stability. This study aimed to evaluate the safety and short- to mid-term outcomes of cementless short-stem THA in patients aged 75 years and older.

Methods

In this retrospective single-surgeon cohort study, 121 cementless short-stem THAs were performed in 117 patients (60% female, n=70; 40% male, n=47) between 2016 and 2024. All patients were aged ≥75 years (range, 75-90 years; mean, 78.7 years). Procedures were conducted via an anterolateral approach in the supine position.

Patient comorbidities were classified according to the American Society of Anesthesiologists (ASA) physical status classification system as ASA I (21.5%, n=26), ASA II (62.8%, n=76), and ASA III (15.7%, n=19), with a mean body mass index (BMI) of 28.5 kg/m². The mean operative time was 57 minutes, and the average hospital stay was 7.6 days. Patients were followed for a mean of 29.5 months (range, 2-110 months).

Results

At final follow-up, four complications (3.3%) were observed: three revision surgeries and one dislocation. The implant survival rate was 98%. No cases of aseptic loosening were recorded. Overall, the complication and revision rates were low and comparable to outcomes reported in younger patient cohorts.

Conclusion

Cementless short-stem THA appears to be a safe and effective option for patients aged 75 years and older, demonstrating excellent short- to mid-term outcomes with low complication and revision rates. These findings support the use of cementless short-stem implants in the elderly population with appropriate surgical technique and perioperative management.