Journal
JOURNAL OF ARTHROPLASTY
Volume 32, Issue 6, Pages 1894-1901Publisher
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.arth.2016.12.029
Keywords
femoral bone preparation technique; cementless femoral stem; radiostereometric analyses; dual X-ray energy absorption; compaction; broaching
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Funding
- Biomet, Inc
- Danish Rheumatoid Association
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Background: Short-term experimental and animal studies have confirmed superior fixation of cement-less implants inserted with compaction compared to broaching of the cancellous bone. Methods: Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery. Results: Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12 degrees (SD 0.13 degrees) in the broaching group were less than mean 0.35 degrees (0.45 degrees) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery. Conclusion: We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems. (C) 2017 Elsevier Inc. All rights reserved.
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