THE CHOICE OF FEMORAL STEM IN THE PROXIMAL FEMORAL FRACTURE

M. Alessio-Mazzola¹ , G. D'Andrea², E. Ghezzi², G. Placella², S. Mosca² , V. Salini²

¹ IRCCS San Raffaele Hospital, Milan, Italy
² Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy

Correspondence to:

Journal of Orthopedics 2024 September-December; 16(3): 150-160

Received: 27 September 2024 Accepted: 10 November 2024

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Abstract

Proximal femoral fractures are common in elderly patients and are associated with significant morbidity and healthcare costs. Hip arthroplasty, including hemiarthroplasty and total hip arthroplasty, is a standard treatment for displaced femoral neck fractures, particularly in older adults. A critical aspect of these procedures is the selection of the femoral stem, which influences early mobility recovery and long-term implant outcomes. This review discusses the key considerations in femoral stem selection, including cemented versus cementless fixation, stem geometry, material composition, and modularity. Cemented stems are favored in elderly patients with osteoporotic bone due to their ability to provide immediate mechanical stability. In contrast, cementless stems are preferred in younger patients due to their potential for long-term biological fixation through osseointegration. Modular stems offer intraoperative flexibility but present a higher risk of mechanical complications. Femoral stem selection should be tailored to the patient’s age, bone quality, and functional demands to minimize complications and optimize clinical outcomes.

Keywords: arthroplasty, hemiarthroplasty, proximal femoral fractures, stem, total hip arthroplasty