Uncemented tapered fluted stems can provide durable fixation during primary total hip arthroplasty.

These stems are relatively simple to use as they require only reaming the canal until one achieves axial and rotational stability.

These stems are especially helpful in the face of excessive femoral version, coxa valga, and small femurs and in posttraumatic deformity (Figure 10.1).

Routine hip retractors.

System specific tapered reamers to prepare canal.

System specific tapered trial implants.

Trial heads including 28 and 22 mm, as some of these patients will have very small acetabular components.

Surgical approach may be according to surgeon preference. This implant may be placed easily by various anterior, lateral, or posterior approaches.

Drape the whole or a majority of femur.

Position such that it is easy to get an intraoperative radiograph if desired.

Know patient’s preoperative leg length discrepancy.

Template cup size and position.

Template femoral component size on anteroposterior and lateral radiographs of the femur. Template the desired neck resection level.

Using the tip of trochanter as a secondary check for anticipated neck resection is helpful. In general, the tip of greater trochanter should be at the level of the center of the femoral head.

Perform desired approach to hip joint.

Perform femoral neck osteotomy according to the preoperative plan.

Prepare acetabulum, place cup with trial liner.