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The FMS-anatomic stem previously demonstrated favourable mid-term results. Its successor, the Anatomic Fit stem, was developed with a reduced hydroxyapatite-coated area to enhance proximal load transfer and a narrower lateral flare to facilitate insertion. This study aimed to analyze the long-term clinical and radiographic outcomes of these stems.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The one-hundred seventy-eight hips underwent total hip arthroplasty using either the FMS-anatomic or Anatomic Fit stem. After applying exclusion criteria, 119 hips (36 FMS-anatomic and 83 Anatomic Fit) were analyzed. Clinical and radiographic outcomes were assessed, and stem survival was evaluated using Kaplan\u2013Meier analysis with stem revision as the endpoint.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The 15- and 20-year survival rates were 97.2% and 94.4% for the FMS-anatomic stem, and 98.8% for the Anatomic Fit stem at both time points, with no significant difference. Spot welds were observed in nearly all cases, but their distribution differed significantly: zones 2 and 6 in the FMS-anatomic group and zones 1 and 7 in the Anatomic Fit group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Stress shielding of Grade 3 or higher occurred in 16.5% of FMS-anatomic stems and 33.7% of Anatomic Fit stems (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Both stems showed excellent long-term survival and proximal fixation. However, the Anatomic Fit stem did not reduce stress shielding, despite its modified design intended to improve load transfer.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00264-025-06624-y","type":"journal-article","created":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T05:11:32Z","timestamp":1757135492000},"page":"2509-2517","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long-term results of the metaphyseal-loading anterolaterally flared anatomic femoral stem for total hip arthroplasty"],"prefix":"10.1007","volume":"49","author":[{"given":"Makoto","family":"Kitade","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuro","family":"Tani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Matsumine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,6]]},"reference":[{"key":"6624_CR1","first-page":"181","volume-title":"Basic orthopaedic biomechanics and mechano-biology","author":"VC Mow","year":"2005","unstructured":"Mow VC, Gu WY, Chen FH (2005) Structure and function of articular cartilage and meniscus. 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