Femoral de-escalation during revision total hip arthroplasty using a rectangular-taper shortened stem

Long stems with diaphyseal fixation are widely used in revision total hip arthroplasty (RTHA) but may increase surgical complexity and compromise femoral bone stock. Primary femoral stems, used as a de-escalation strategy, could simplify RTHA in selected patients as a bone preserving strategy. This study aimed to evaluate the clinical and radiographic outcomes of this technique using a cementless rectangular-taper shortened stem during both components RTHA.

Between January 2019 and January 2025, 301 both components RTHA were prospectively included in our institutional total joint registry. Among them, 23 RTHA (20 patients, 14 men, mean age at revision = 63 years [54-71]) with femoral de-escalation with the use of a cementless rectangular-taper shortened stem and a dual mobility cup construct were identified and retrospectively reviewed at latest follow-up, focusing on complications related to this reconstruction technique. Clinical outcome was evaluated with the Harris Hip Score (HHS).

At a mean follow-up of 48 months (23-75), no postoperative periprosthetic fracture, mechanical failure or early loosening of the femoral reconstruction occurred. One early dislocation occurred at 41 days, managed by closed reduction without recurrence at latest follow-up. The mean HHS significantly improved from 70 (59-83) preoperatively to 94 (64-100) postoperatively, with 96% of patients achieving HHS ≥ 80 at latest follow-up.

In selected patients undergoing RTHA with limited femoral bone loss, femoral de-escalation with a cementless rectangular-taper shortened stem demonstrated reliability for femoral reconstruction with no component-related complication and significant functional improvement at short-term follow-up.