Short vs standard stems perioperative blood loss and complication risk

Abstract Background and objectives Femoral stem design may influence perioperative blood loss and transfusion requirements in total hip arthroplasty (THA). While short stems are increasingly used, their independent effect on hematologic and clinical outcomes remains unclear. This study aimed to compare perioperative blood loss, transfusion requirements, and postoperative complications between short and standard femoral stems in elective primary THA. Methods This retrospective cohort study analyzed elective primary THAs stratified by femoral stem design (short vs standard). Outcomes included intraoperative blood loss, total blood loss, hidden blood loss, allogeneic packed red blood cell transfusion, and postoperative complications. Multivariable linear and logistic regression models with robust standard errors were applied to estimate adjusted associations, controlling for age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) class, operative time, preoperative hemoglobin, and cement usage. Results Short stems were independently associated with lower intraoperative blood loss (adjusted mean difference − 125.8 mL, 95% CI − 181.2 to − 70.4) and lower total blood loss (adjusted mean difference − 130.0 mL, 95% CI − 222.1 to − 37.9) compared with standard stems. No independent association was observed for hidden blood loss. Although unadjusted transfusion rates were lower with short stems, the adjusted association did not reach statistical significance (adjusted OR 0.57, 95% CI 0.28–1.14). Stem design was not independently associated with postoperative complications. Conclusions In elective primary THA, short stems are associated with reduced intraoperative and total blood loss compared with standard stems, while hidden blood loss and postoperative complication rates are comparable. Differences in transfusion risk appear to be driven primarily by patient-related factors rather than stem design alone. Level of evidence III Retrospective comparative cohort study.