Fracture Morphology and Extraction-Related Femoral Damages in Short Versus Standard Cementless Stems: Analyses of Vancouver B2 Fractures and Well-Fixed Nonfracture Revisions

Background Short-stem total hip arthroplasty is increasingly used because of its bone-preserving, minimally invasive concept. Revision may occur in two fundamentally different situations: Vancouver B2 periprosthetic femoral fracture (PFF) with an unstable stem or removal of a well-fixed osseointegrated stem for a nonfracture indication. This study evaluated whether stem design is associated with distinct fracture morphology and extraction-related femoral damage. Methods This retrospective two-center cohort included 102 revision total hip arthroplasties performed between 2021 and 2025: standard-stem Vancouver B2 PFF (n = 44), short-stem Vancouver B2 PFF (n = 12), standard-stem nonfracture revision (n = 27), and short-stem nonfracture revision (n = 19). Primary analysis compared fracture localization and morphology between Vancouver B2 cohorts; secondary analysis compared intraoperative fractures and extraction-related reconstruction requirements between well-fixed nonfracture cohorts. Perioperative outcomes were reported descriptively. Results In Vancouver B2 PFF, short stems more frequently involved the greater trochanter (58.3%), lesser trochanter (33.3%), calcar (41.7%), and lateral cortex (58.3%) vs standard stems (40.9%, 9.1%, 13.6%, and 31.8%, respectively). During well-fixed nonfracture revision, intraoperative fracture occurred in 7/19 (36.8%) short-stem vs 4/27 (14.8%) standard-stem revisions. Cerclage fixation was required in 10/19 (52.6%) vs 4/27 (14.8%), and modular diaphyseal reconstruction in 9/19 (47.4%) vs 8/27 (29.6%), respectively. Conclusions Short and standard cementless stems showed different femoral involvement in Vancouver B2 PFF. Separately, removal of well-fixed short stems was frequently associated with extraction-related proximal femoral damage and additional fixation. These findings do not establish universal superiority of either design but emphasize considering clinical scenario, fixation pattern, and stem geometry independently when planning revision THA.