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Objectives and questions: The use of cementless short-stem prostheses in total hip arthroplasty (THA) has gained popularity due to bone preservation and favorable biomechanical properties. However, their suitability for elderly patients remains debated. This study evaluates the indications, survivorship, and loosening rates of short-stem prostheses in patients aged ≥75 years.

Material and methods: A retrospective analysis was conducted on 125 patients (≥75 years) who underwent cementless short-stem THA between 2014 and 2024. Indications for short-stem implantation, including osteoarthritis and femoral bone quality, were documented. Clinical outcomes were assessed using the Harris Hip Score (HHS) at 12 months postoperatively. Implant survivorship and radiological loosening rates were analyzed.

Results: At a mean follow-up of 3.5 years, overall implant survivorship was 96%. Loosening occurred in 2.5% of cases, with revision surgery required in three patients (2.4%). The mean HHS improved from 50 preoperatively to 85 at 12 months postoperatively (p < 0.05). Periprosthetic fractures were observed in one patient (0.8 %), and the overall complication rate was 4%. No significant differences in outcomes were noted compared to conventional stems.

Discussion and conclusions: Cementless short-stem THA in elderly patients demonstrated favorable survivorship and low loosening rates. Proper patient selection remains crucial, but these findings suggest that short stems may represent a viable alternative even in the elderly population.