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Updated: Jul 24, 2025
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
The history of the development of the regular straight stem in hip arthroplasty
Hanna Wellauer1,2, Roman Heuberger3, Emanuel Gautier1
1Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland.
Insights
This review details the evolution of straight stems in total hip arthroplasty, highlighting innovations in fixation techniques and materials. It explores how early designs by Charnley paved the way for modern, long-lasting hip implants.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Total hip arthroplasty is a cornerstone treatment for end-stage hip disease.
- Early innovations by Charnley addressed wear and friction, crucial for implant longevity.
- Understanding the historical development of stem design is vital for current orthopedic practices.
Purpose of the Study:
- To present a narrative review of major developments in regular straight stems for hip arthroplasty.
- To document the rationale behind design evolution and identify historical links.
- To provide an overview of fixation principles for cemented and non-cemented stems.
Main Methods:
- Narrative review of historical literature and scientific documentation.
- Analysis of key developments in hip arthroplasty stem design.
- Examination of fixation principles (cemented and non-cemented) and material science.
Main Results:
- Charnley's low frictional torque arthroplasty introduced critical advancements in bearing couples and head size.
- Two main principles for cemented stem fixation, force-closed and shape-closed, demonstrate good long-term revision rates.
- Non-cemented fixation relies on achieving primary stability for osteointegration, requiring suitable surface structures and biocompatible materials.
Conclusions:
- The evolution of straight stems in hip arthroplasty has significantly improved patient outcomes.
- Both cemented and non-cemented fixation methods have distinct advantages and require specific design considerations.
- Continued research into biomaterials and surface engineering is essential for enhancing implant osseointegration and durability.
Abstract:
Since the middle of the 20th century, total hip arthroplasty has become a very successful treatment for all end-stage diseases of the hip joint. Charnley solved with his low frictional torque arthroplasty the problem of wear and friction with the introduction of a new bearing couple and the reduction of the head size, which set the prerequisite for the further development of stem design. This narrative review presents the major developments of regular straight stems in hip arthroplasty. It does not only provide an overview of the history but also assembles the generally scarce documentation available regarding the rationale of developments and illustrates often-unsuspected links. Charnley's success is based on successfully solving the issue of fixation of the prosthetic components to the bone, using bone cement made of polymethyl-methacrylate. In the field of cemented anchorage of the stem, two principles showing good long-term revision rates emerged over the years: the force-closed and the shape-closed principles. The non-cemented anchorage bases on prosthesis models ensure enough primary stability for osteointegration of the implant to occur. For bone to grow onto the surface, not only sufficient primary stability is required but also a suitable surface structure together with a biocompatible prosthetic material is also necessary.
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