Varus positioning is the most common femoral malposition in total hip arthroplasty (THA). The aim of this study was to compare the long-term results of an anatomical cementless femoral stem positioned in varus with those in neutral alignment.

Data were prospectively collected and retrospectively reviewed for all patients who received a cementless anatomical femoral stem in THA between 1998 and 2008. After exclusion criteria applied, 127 stems had an varus axis deviated by more than 3 degrees (varus group) and 156 had an alignment between 0 and 2.9° from the femoral axis (neutral group). Survivorship rates, complications, clinical scores, thigh pain, radiological score, cortical hypertrophy and filling rate were analyzed. Mean follow-up was 10 years.

Inclusion Criteria:

• All patients received by several senior surgeons, the same standardized posterolateral total hip arthroplasty, and the same rehabilitation protocol.

Exclusion Criteria:

• Etiologies other than osteoarthritis (osteonecrosis, fracture, dysplasia, rheumatoïd arthritis),
• Complex cases with additional procedure,
• Dual-taper modular or cemented stem,
• Incomplete preoperative data or less than one-year postoperative data.

The investigators identified all patients who underwent proximal HA-coated anatomic tapered femoral stem primary THAs between October 1998 and July 2008, through our institutional total joint registry. The data were prospectively collected on the Orthowave© database. This included patients who had an uncemented ABG-2 stem (Stryker, Mahwah, NJ). The study was a test-case retrospective analysis and an institutional review board approval was obtained prior to initiation of the study.