Conservative Stems in Total Hip Replacement

Arthritis of the hip primarily involves the joint surfaces. Intuitively the principal objective in the surgical management of arthritis is to replace the damaged articular surfaces. However, early attempts at conservative replacement failed both because of inadequate fixation and failure of the articulation. Conservative hip implants take less bone at the time of surgery and preserve bone in the longer term with more physiological loading. In addition, the implants are usually easier to insert with soft tissue sparing surgery. While these implants potentially offer an additional option in the surgical management of younger patients with arthritis, this advantage is negated if there is an unacceptably high incidence of premature failure. This paper explores the evolution and results of conservative total hip prostheses that culminated in the contemporary designs.