Clinical performance and durability of short taper-wedge femoral stems in direct anterior total hip arthroplasty: Insights from a five-year retrospective analysis

Background: Short-taper-wedge stems have gained increasing adoption in direct anterior total hip arthroplasty owing to their bone-preserving geometry and favorable suitability for implantation through limited exposures. The objective of this study was to assess 5-year clinical and radiographic outcomes, implant survivorship, and risk factors for failure. We hypothesized that mid-term survivorship of short-taper-wedge stems would be equivalent to or exceed that of traditional designs, with a lower complication rate in Dorr-A and B femora. Methods: A retrospective analysis was conducted on a consecutive cohort of 128 primary-DA-THAs performed with the Taperloc Microplasty stem. Clinical outcomes were measured using the Harris Hip Score (HHS), while radiographic evaluations assessed implant positioning, subsidence, and complications. Follow-up was completed at 2-weeks, 6-weeks, 6-months, 1-year, 2-years, and 5-years. Results: Revision-free implant survivorship was 92.7% at five-years. The HHS improved significantly from a mean of 47.5 preoperatively to 96.8 at five-years (p < 0.0005). The overall complication rate was 7.03%, comprised of early implant subsidence and periprosthetic fractures in older patients (mean 77.8 years) with diminished bone stock. Multivariate analysis identified increasing age as the sole predictor of complications (p = 0.008), all of which were successfully managed with revision to modular, diaphyseal-engaging-femoral stems. Conclusions: Short-taper-wedge-femoral stems are a reliable option for primary-DA-THA, with revision-free survivorship of 92.7% at 5-years-postoperatively. Early periprosthetic fractures, the predominant complication in this series, occurred in older patients with brittle bone, supporting use of cemented fixation in this high-risk population. Long-term monitoring is underway to further inform durability and outcomes with use of this stem in primary DA-THA settings.