¹Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Munich, Deutschland
²Department of Orthopedics and Trauma, Medical University of Graz, Graz, Österreich

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Objectives and questions: Registry data indicate a growing use of short-stem systems with uncemented fixation, likely due to their technical advantages in minimally invasive implantation. Literature increasingly reports their application, even in rare indications such as femoral neck fractures. As a result, an increased number of well-osteointegrated short stems requiring revision can be expected in the future. This study aimed to analyze risk factors and potential challenges in revision cases and to review the existing literature on this topic.

Material and methods: A retrospective database analysis was conducted at two university centers (Germany and Austria) from 2022 onwards. Inclusion criteria were the extraction of a well osteointegrated short-stem system (minimum of six months post-implantation). Patient-specific risk factors and intraoperative complications were recorded. A PubMed analysis was performed for research on relevant literature.

Results: Ten patients (4 female; age: 66.3 ± 13.9 years) with short stems requiring extraction after completed osteointegration (6.1 ± 5.2 years post-implantation) were identified. Indications for revision included infection (n=5), periprosthetic fracture (n=4), and metallosis (n=1). Stem removal resulted in calcar destruction in seven cases and trochanteric fracture in eight cases, with four requiring additional osteosynthesis. Modular revision stems were necessary in seven cases. A PubMed search for the specific research question yielded no relevant results on this specific topic.

Discussion and conclusions: Extraction of osteointegrated short stems posed a high risk of trochanteric destruction, leading to additional instability. The frequent necessity for modular revision stems contradicted the concept of a “bone-preserving” revision. Particularly in cases of pronounced distal/diaphyseal fixation (valgus neck configuration, Dorr-B femur) with plasma-spray-coated implants, the typical curvature of short stems complicated extraction. We recommend careful preoperative indication assessment, considering future revision requirements.