This narrative review from Khanuja et al. (JBJS 2011) examines the spectrum of cementless femoral stem designs used in total hip arthroplasty, proposes a six-type classification system based on stem geometry and fixation location, and summarizes long-term clinical and radiographic outcomes for each stem type.
When selecting a cementless femoral stem, match the stem type to the anatomy: proximally tapered stems (Types 1–3) suit most routine cases and preserve proximal bone loading, while Types 3B, 3C, 4, and 5 are preferred when diaphyseal fixation is needed (Dorr Type-C bone, deformity, revision).
Counsel all patients that some degree of proximal stress-shielding is expected regardless of design.
This narrative review from Khanuja et al. (JBJS 2011) examines the spectrum of cementless femoral stem designs used in total hip arthroplasty, proposes a six-type classification system based on stem geometry and fixation location, and summarizes long-term clinical and radiographic outcomes for each stem type.
When selecting a cementless femoral stem, match the stem type to the anatomy: proximally tapered stems (Types 1–3) suit most routine cases and preserve proximal bone loading, while Types 3B, 3C, 4, and 5 are preferred when diaphyseal fixation is needed (Dorr Type-C bone, deformity, revision).
Counsel all patients that some degree of proximal stress-shielding is expected regardless of design.