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Updated: Jun 25, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Femoral stem tip orientation and surgical approach in total hip arthroplasty
P D Vaughan1, P J Singh, R Teare
1Department of Trauma and Orthopaedics, Heatherwood and Wexham Park NHS Trust, Slough, Berkshire, UK. drphilipvaughan@yahoo.com
Introduction:
A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation.
Methods:
We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane.
Results:
There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01).
Discussion:
Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
