An Update on Cementless Femoral Fixation in Total Hip Arthroplasty

Cementless stems can be categorized using the updated classification system.

Short stems were designed as an alternative to conventional stems with the advantage of bone preservation, and they have grown in popularity with promising results; however, long-term outcomes are lacking.

Hydroxyapatite coating appears to have no advantage with respect to stem loosening.

The literature has shown no difference in revision rates between modular and nonmodular stems; however, with the advantages of equalizing limb lengths and offset come the drawbacks of corrosion and junctional fatigue failure of modular implants.

There is increasing use of cementless stems, including in octogenarians, with promising outcomes compared with cemented stems; however, there is a higher risk of periprosthetic fractures with cementless fixation, particularly in elderly female patients.