Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study - 09/08/26

Doi : 10.1016/j.otsr.2026.104816

Alexandre Gounot ^a,^b,⁎ , Claire Bastard ^a,^b, Marc Lin ^a,^b, Alain Sautet ^a,^b, Aymane Moslemi ^a,^b

^a Sorbonne Université, Paris, France

^b Département de Chirurgie Orthopédique et Traumatologique, CHU Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 09 August 2026

Abstract

Background

Achieving reliable primary fixation in elderly patients with femoral neck fractures remains challenging, particularly when using uncemented stems. Calcar-guided metaphyseal–diaphyseal short stems have been proposed as an alternative; however, evidence regarding their mechanical safety in fracture settings remains limited. This study aimed to evaluate the incidence of early periprosthetic femoral fracture following implantation of a calcar-guided short stem and to identify factors associated with fracture and stem subsidence.

Hypothesis

Calcar-guided short stems provide satisfactory mechanical safety without an excessive rate of early periprosthetic fracture in elderly fracture patients.

Materials and methods

We conducted a retrospective single-center cohort study including consecutive patients aged ≥70 years treated between 2017 and 2025 with total hip arthroplasty or hemiarthroplasty using an Optimys® short stem through a minimally invasive anterior approach. The primary endpoint was intraoperative or early postoperative periprosthetic femoral fracture requiring revision within 3 months. Secondary outcomes included clinically relevant stem subsidence (>2 mm). Given the low number of events, univariate and multivariable analyses were performed using Firth penalized logistic regression.

Results

A total of 433 patients were included (mean age 84.6 ± 7.7 years). Overall, 21 femoral mechanical complications (4.9%) were observed, including 3 intraoperative calcar fractures treated with cerclage fixation and 18 early postoperative periprosthetic femoral fractures requiring revision surgery. Stem subsidence greater than 2 mm was observed in 24 patients (5.8%). No independent predictors of fracture were identified. Medial cortical support was the only independent protective factor against stem subsidence (OR = 0.08; 95% CI, 0.03–0.22; p < 0.001).

Discussion

Metaphyseal–diaphyseal short stems appear to be a reasonable option for the treatment of femoral neck fractures in elderly patients. Primary stability appeared to depend mainly on achieving adequate medial cortical support. Longer follow-up is required to assess the long-term performance of these implants.