JB JS Open Access. 2026 Jul 24;11(3):e25.00300. doi: 10.2106/JBJS.OA.25.00300. eCollection 2026 Jul-Sep.
ABSTRACT
» Native femoral version (NFV) demonstrates inconsistent correlation with prosthetic femoral version (PFV) and should not be relied upon in isolation for femoral version planning in cementless total hip arthroplasty (THA). » Final stem version is strongly influenced by intramedullary canal morphology, fixation mechanics, and stem design philosophy. Straight, tapered wedge, and diaphyseal-engaging stems demonstrate greater variability in PFV, whereas anatomic and calcar-guided short stems may better preserve NFV. » Current planning methods inadequately characterise three-dimensional canal anatomy and fail to simulate canal-stem interaction, limiting accurate prediction of PFV. » Intraoperative estimation methods remain inconsistent and highly dependent on surgeon experience. Robotic-assisted THA enables real-time PFV measurements and supports femur-first strategies to optimise combined anteversion, although current systems still rely on computed tomography templating without true canal-stem interaction modelling. » Reliable PFV prediction will likely require next-generation planning platforms integrating internal canal anatomy, statistical shape modelling and artificial intelligence-driven modelling into planning workflows.
PMID:42488890 | PMC:PMC13391145 | DOI:10.2106/JBJS.OA.25.00300
