A surgeon argues that where a hip stem sits in the femur matters more than its angle. Neck-residing stems align naturally without rotation, reducing anterior bone impingement during flexion and the posterior instability that causes periprosthetic fractures, the most common hip fracture in elderly patients.
Chapters
'Cause anteversion is a 60-year-old mistake. If your stem resides in the shaft, it obeys the shaft, if you like. You have to rotate and divert it to replicate the centric position. But if it resides in the neck, it will normally anti-tilt with no need to rotate. So anterior bone impingement, posterior prosthetic impingement, big differences, and it's worth just running down the list. ABI occurs in flexion at the front of the joint. It's remote from the joint. It's an abutment phenomenon which causes displacement, posterior instability. And if it happens aggressively, such as in a fall, it can cause periprosthetic fracture. That is actually what causes the most common hip fracture in the unreplaced elderly parodic population. I believe that's the same mechanism for replaced hips. Why would it differ? And it's harmless to the components. It doesn't hurt them, but it can separate them. So proposed solution, and this is just one example, but I'm proposing a, uh, a neck residing stem, neck retaining stem, side-specific.