Evolution of cemented stems

John Charnley was responsible for pioneering successful cemented hip arthroplasty. Changes in stem design were made in response to early complications such as stem fracture. Various philosophies of stem biomechanics emerged, namely stems performing in the taper slip mode and stems performing as a composite beam. Both stem designs may be successful, although it is important not to mix biomechanical philosophies. Later evolutions have occurred in response to surgical flexibility, specifically modularity and offset options. These attributes can impart new demands on the stem and, in some cases, retrograde developments have occurred. Cemented stems may yield excellent long-term results and have the potential to limit fixation to the proximal femur and establish a metaphyseal-loading regimen. The latest design of taper slip stems, such as the C-stem (DePuy Orthopaedics, Warsaw, Ind), may have advantages in maintaining proximal bone stock and preserving host bone. The historical developments and evolution of the cemented stem in total hip arthroplasty (THA) are discussed.