Mid- to long-term outcomes of short stem total hip arthroplasty in patients younger than 55 years: a systematic review and meta-analysis.

BACKGROUND

Short-stem total hip arthroplasty (THA) aims to preserve proximal femoral bone stock and promote physiological load transfer compared to conventional cementless stems. This design is particularly relevant for younger, active patients, in whom long-term implant survival and bone preservation are critical.

OBJECTIVE

To systematically review and meta-analyse the functional and radiological outcomes of short-stem THA in young patients.

METHODS

A systematic search of Medline, Embase, PubMed, and the Cochrane Library was conducted to May 2025 following PRISMA guidelines. Eligible studies included patients with mean age <55 years and ⩾4.5 years mean follow-up. Primary outcome was Harris Hip Score (HHS) or modified Harris Hip score (mHHS); secondary outcomes were complications, survivorship, and radiological findings.

RESULTS

32 studies involving 4082 hips (mean age 46.7 years, mean follow-up 8.6 years) were included. Mean HHS improved from 45.3 to 93.8. Complications were infrequent, including intraoperative fracture (1.6%), dislocation (0.6%), and infection (0.4%). Radiological changes, including osteolysis (1.3%), heterotopic ossification (1.9%), and stem subsidence ⩾2 mm (0.7%), were uncommon. Stem survivorship free from aseptic loosening was 99.7%. The overall revision rate was 1.6%. Subgroup analyses indicated better outcomes and lower revision rates with posterolateral approaches and ceramic-on-ceramic bearings.

CONCLUSIONS

Short-stem total hip arthroplasty in patients younger than 55 years appears to be associated with excellent mid- to long-term functional outcomes, low complication rates, and high implant survivorship. While these findings suggest that short stems are a safe and durable option for young, active patients, substantial heterogeneity across studies and the limited randomised evidence warrant cautious interpretation. These findings are hypothesis-generating and warrant confirmation in adequately powered prospective studies.PROSPERO registration:No: CRD420251046310.