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.