SynthesisBMC musculoskeletal disorders2026
A comparative meta-analysis of stress shielding between short-stem and conventional femoral stem in total hip arthroplasty.
Synthesis in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundStress shielding-related complications remain a key clinical challenge in total hip arthroplasty (THA). While short-stem prostheses have shown potential bone-preserving benefits in preclinical and single-center studies, pooled high-quality evidence remains inconsistent. This study aimed to compare periprosthetic bone mineral density (BMD) changes between short-stem and conventional straight-stem THA, and evaluate the stress-shielding benefits of short-stem designs.
methodsWe systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to 31 March 2026 for eligible randomized controlled trials (RCTs). Meta-analysis was performed using standardized mean differences with 95% confidence intervals. Two reviewers independently assessed study quality via the GRADE criteria, and a minimum clinically important difference framework was applied to interpret BMD changes.
resultsSix RCTs were included, involving 398 patients (202 hips with short-stem THA, 225 with conventional THA). Within 12 months postoperatively, short-stem THA showed significantly better BMD preservation in Gruen zone 1 at 3 (SMD = 0.22, P = 0.04), 6 (SMD = 0.51, P = 0.02) and 12 months (SMD = 0.59, P = 0.002), and in Gruen zone 7 at 6 months (SMD = 0.65, P < 0.00001). Subgroup analysis confirmed significant BMD preservation benefits with novel-design short stems (12-month Gruen zone 1: SMD = 0.94, P < 0.00001), while traditional tapered short stems showed no significant difference from conventional stems. No between-group differences were found in other Gruen zones.
conclusionThis meta-analysis provides moderate-quality evidence that novel-design short-stem THA is associated with better short-term proximal femoral BMD preservation compared with conventional stems within 1 year postoperatively, with benefits highly specific to prosthesis design subtypes. It must be emphasized that periprosthetic BMD is a surrogate endpoint, and the observed short-term bone preservation advantage has not yet been definitively linked to reduced revision rates or decreased aseptic loosening in large-scale registry data. Stress shielding is a chronic, ongoing process, and the clinical implications of BMD differences measured at 12 months require validation through long-term follow-up studies. Clinical decision-making should be individualized, and further large-sample, long-term RCTs are needed to determine whether the observed BMD benefits translate into improved hard clinical outcomes. TRIAL REGISTRATIONS: PROSPERO registration number: CRD420250653026.
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