Abstract
<title>Abstract</title> <p>Purpose To evaluate the influence of chronological age on the mid-term clinical outcomes and implant survivorship of cementless short-stem total hip arthroplasty (THA) by comparing patients aged over 60 years versus those aged 60 years and under. Methods A retrospective propensity score–matched study included 509 patients who underwent Metha® short-stem THA. Patients were stratified into two age groups (> 60 vs. ≤60 years). Patients were stratified into two age groups consisting of older (over 60 years) and younger (60 years and under) patients. After matching (1:4) for sex, BMI, ASA class, diagnosis, and Dorr femoral type, 76 older and 304 younger patients were analyzed with a minimum follow-up of five years. Outcomes included Harris Hip Score (HHS), Forgotten Joint Score (FJS), patient satisfaction, radiographic fixation, stem subsidence (> 3 mm), complications, and implant survivorship using Kaplan–Meier analysis. Results Baseline characteristics were well balanced after matching (SMD < 0.1). At five years, postoperative HHS (97.3 vs. 97.7; p = 0.16) and FJS (95.1 vs. 95.7; p = 0.31) were comparable between the older and the younger groups, with > 97% reporting high satisfaction. Radiographic fixation and subsidence rates were similar between groups. Intraoperative femoral fractures occurred more frequently in the older group (11.8% vs. 3.0%; p = 0.023). Five-year survivorship for revision for any reason was 97.4% in the older group and 98.7% in the younger group (p = 0.41). Conclusion Cementless short-stem THA demonstrated excellent mid-term outcomes and comparable survivorship across age groups. Although intraoperative femoral fractures were more frequent in older patients, overall outcomes were not compromised, suggesting that chronological age alone should not preclude metaphyseal-anchoring short stems when bone quality and femoral morphology are appropriate.</p>