Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study.

Cohort studyOrthopaedics & traumatology, surgery & research : OTSR· Aug 2026

Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study.

Alexandre Gounot, Claire Bastard, Marc Lin … Aymane Moslemi

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Orthopedic TraumaCohort studyTreatmentQ1IF 3.0

Medial cortical support is linked to markedly less short-stem subsidence risk.

Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study.

Alexandre Gounot … Aymane Moslemi

Orthopaedics & traumatology, surgery & research · Aug 2026 · Q1 in Orthopedics

Background

Achieving reliable primary fixation in elderly patients with femoral neck fractures remains challenging, particularly when using uncemented stems.

Purpose

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.

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.

n = 433 patients

Results

poor medial cortical contact sharply raises subsidence risk

OR 0.08 (95% CI 0.03 to 0.22)

CI excludes the null - significant

More results

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%).

More results

No independent predictors of fracture were identified.

DISCUSSION: Metaphyseal-diaphyseal short stems appear to be a reasonable option for the treatment of femoral neck fractures in elderly patients.

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Conclusion

LEVEL OF EVIDENCE: IV; retrospective cohort study.

Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study.

Mechanical safety of calcar-guided short stems in elderly femoral neck fractures: A 433-patient cohort study.

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