How Femoral Neck Resection Height and Dorr Type Affect the Primary Stability of Cemented Short Stems: An In Vitro Study

Implantation of a femoral stem in total hip arthroplasty alters physiological load transfer within the proximal femur. Short-stem designs aim to preserve bone stock and maintain proximal load sharing, yet the influence of femoral neck resection height and its interaction with femoral morphology on primary stability remain insufficiently understood. This in vitro biomechanical study investigated these effects using 33 human femora classified as Dorr B or C. In a paired design, a cemented calcar-guided short stem was implanted with either a low (standard) or +5 mm higher femoral neck resection. Specimens underwent cyclic fatigue loading to assess reversible and irreversible micromotion and interface strain, followed by ultimate compression to quantify global fixation strength. Primary stability was assessed by reversible and irreversible translation of the prosthetic head center of rotation and by cortical interface strain measurements using digital image correlation. Overall fixation strength and irreversible deformation remained comparable across resection heights and Dorr types. In contrast, resection height and femoral morphology influenced reversible micromotion and interface strain, with higher resection reducing reversible micromotion, particularly in Dorr C femora and shifting lateral interface strain toward compression. These findings suggest that surgical technique and femoral morphology mainly affect local, reversible bone–cement–implant mechanics rather than global fixation strength.