Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2021; 12(8): 534-547
Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.534
Calcar-guided short-stem total hip arthroplasty: Will it be the future standard? Review and perspectives
Karl Philipp Kutzner
Karl Philipp Kutzner, Department of Orthopaedic Surgery, St Josefs Hospital Wiesbaden, Germany, Wiesbaden 65189, Germany
Karl Philipp Kutzner, Department of Hip Surgery, Gelenkzentrum Rhein-Main, Wiesbaden 65183, Germany
Karl Philipp Kutzner, Center of Orthopedics and Traumatology, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
Author contributions: Kutzner KP conducted the review and wrote the manuscript.
Conflict-of-interest statement: The author is a medical advisor for Mathys Ltd., Bettlach, Switzerland. No further conflicts of interest have been declared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Karl Philipp Kutzner, MD, PhD, Associate Professor, Department of Orthopaedic Surgery, St Josefs Hospital Wiesbaden, Germany, Beethovenstr. 20, Wiesbaden 65189, Germany. kkutzner@joho.de
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: May 3, 2021
Revised: May 10, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 18, 2021
Processing time: 178 Days and 5.2 Hours
Abstract

Short stems in total hip arthroplasty (THA) are becoming increasingly popular. In Germany, already 10.4% of all primary THAs are performed using a cementless short stem. The concept of modern, calcar-guided, short stems aims for an individualized reconstruction of the hip anatomy by following the calcar of the femoral neck, a bone- and soft-tissue-sparing implantation technique, and physiological loading. The stem design uses either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication. These individualized anchorage types increase the potential indications for the safe use of a short stem. The design features may account for potential advantages of current short stem implants compared with earlier short-stem designs, particularly in cases of reduced bone quality or osteonecrosis of the femoral head and femoral neck fractures. The implantation technique, however, requires distinct knowledge regarding the characteristics of varus and valgus positioning, with the potential for clinical consequences. A learning curve for surgeons new to this technique must be taken into account. Cortical contact with the distal lateral cortex appears to be crucial to provide sufficient primary stability, and the use of intraoperative imaging to identify “undersizing” is highly recommended. Current results of several national registries indicate that calcar-guided short stems are among the most successful implants in terms of mid-term survivorship. However, long-term data remain scarce. This review introduces the characteristics of calcar-guided short-stem THA and summarizes the current evidence.

Keywords: Total hip arthroplasty; Short stem; Calcar-guided; Classification; Indications; Anchorage; Optimys

Core Tip: Modern calcar-guided short stems offer numerous advantages compared with conventional total hip arthroplasty (THA). The broad potential to reconstruct the individual hip geometry, the reduced proximal bone remodeling, and the simplified soft-tissue-sparing implantation represent true accomplishments in THA. Mid-term data indicates encouraging outcomes and excellent implant survival. If long-term data confirm these promising results, chances are good that calcar-guided short stems will become the future standard in THA.