Calcar-Guided Short Stems in Total Hip Arthroplasty: A Two-Year Prospective Multicentre Study

Hagen Mittelstaedt1, *, Josef Hochreiter2, Conrad Anderl2, Carsten Johl3, Thomas Krüger4, Wilmar Hubel5, Ulrich Weigert6, Jan C. Schagemann7
1 UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Germany
2 Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Austria
3 Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
4 Helios Klinik Köthen, Hallesche Straße, Köthen (Anhalt), Germany
5 Kreiskrankenhaus Stollberg GmbH, Jahnsdorfer Straße Stollberg, Stollberg, Germany
6 Praxis für Orthopädie und Unfallchirurgie, Friedrichstraße, Erkner, Germany
7 Segeberger Kliniken, Klosterkamp, Segeberg, Germany

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© 2020 Mittelstaedt et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie, Sektion Orthopädie, Ratzeburger Allee 160, 23538 Lübeck, Germany; Tel: +49 (0) 4515 0041107;



Calcar-guided short-stem Total Hip Arthroplasty (THA) is increasingly being used to preserve proximal femoral bone stock for potential later revision surgery.


In this study, we aimed to expand the clinical evidence on calcar-guided short-stem THA used in daily clinical practice, focusing on clinical outcomes as well as radiographic signs of stress shielding and femoral bone loss.


In a prospective multicentre study, we enrolled 213 patients with a total of 224 THAs for mainly degenerative indications. The patients were examined clinically and radiographically 6 to 12 weeks, 12 months, and 24 months postoperatively.


All clinical outcomes improved significantly over the first 6 to 12 weeks compared to preoperative values (P < 0.001). At 24 months, the mean Harris hip score was 95.3 ± 6.7, and the mean visual analogue scale for pain was 1.0 ± 1.7 under load and 0.5 ± 1.3 at rest. We observed early distal stem migration in six patients and late migration in one patient. Additionally, we found 16 cases of radiographic signs indicative of stress shielding. Four patients required stem revision surgery: two for stem migration, one for periprosthetic fracture, and one for deep infection.


Overall, calcar-guided short-stem THA resulted in excellent clinical outcomes after two years of follow-up, and the radiographs revealed few signs of stress shielding. We, therefore, regard calcar-guided short-stem THA as a safe and effective treatment alternative in daily clinical practice.

Keywords: Total hip arthroplasty, Hip prosthesis, Short stem, Metaphyseal fixation, Stress shielding, Migration.