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Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture. We sought to assess this risk within our unit.

Our institution’s arthroplasty database was searched for all primary total hip arthroplasties utilizing short femoral stems performed between July 14, 2009, and August 29, 2022. The overall periprosthetic fracture (PPF) rate and the PPF rate for individual femoral stems were established. Pre-operative x-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF …