Aims. The incidence of thigh pain with the short stem varies widely across different studies. We aimed to evaluate the incidence and characteristics of post-operative thigh pain after using a particular bladed short stem and its potential risk factors. Patients and Methods. We respectively reviewed 199 consecutive patients who underwent unilateral total hip replacement using the Tri-lock stem from 2013–2016, of which 168 patients were successfully followed up with minimum two year clinical follow-up. All information about thigh pain and pre- and postoperative HHS score were gathered and all preoperative and immediate postoperative radiographs were available for review. Any complications were recorded. Results. Of the 168 patients, 34 (20.2%) patients reported thigh pain at a mean 3.1 years after surgery. Of these, 2 (5.9%) reported severe pain (NRS 5 or more). The pain was persistent (from surgery to final follow-up) in 13 patients (38.2%) and subsided within 2 years in 10 cases (29.4%). The most common site of pain was the lateral thigh (70.6%). The HHS improved from a mean 54.2 points preoperatively to 79.8 postoperatively. In 123 cases with radiographs at more than 2 years follow-up, all femoral stems were well-fixed and no revision surgery was needed at the latest. BMI and CFI were found to be independent risk factors for thigh pain after using this particular stem component. Conclusions. The incidence of thigh pain in Chinese THA patients with a bladed short stem component design is as high as 20%. Among them, nearly 40% will have some disruption in sleep or daily life. More than one-third of the cases of thigh pain were persistent. A larger BMI and patients with a funnel-type morphology of the femoral canal are independent risk factors for thigh pain in the setting of this particular stem component

Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant. Methods. All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study. Results. Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. Fifty-two hips (18%) had ≥25% cortical hypertrophy in zone 3 and 91 hips (31%) had ≥25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusion. The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient reported anterior or lateral thigh pain. For any tables or figures, please contact the authors directly

Background. Although thigh pain is an annoying problem after total hip arthroplasty (THA), little information has been known about its natural course. Methods. To determine the frequency, time of onset, and duration of thigh pain after cementless THA, we evaluated 240 patients (240 hips) who underwent primary THA because of femoral head osteonecrosis with the use of a single tapered stem. Results. Twenty-seven patients (11.3%) experienced thigh pain during the follow-up of 3–11 years(mean, 84 months). The pain developed 2–78 months (median, 25 months) after THA. The 75% of pain developed within 36 months. In 25 patients, the pain disappeared postoperatively 1 month-64 months (mean, 17.4 months), and 2 patients (7.4%, 2/27) had persistent thigh pain. There were no differences in the latest Harris Hip Score between the thigh pain group and no thigh pain group. Conclusion. Our results provided basic information about the natural history of thigh pain after cementless THA with a tapered stem design

One of major problems in Total Hip Arthroplasty is thigh pain. We have examined the effect of femoral canal injection of Calcium Phosphate Paste (CPP) for cementless THA. CPP is a mixture of alpha Tri-Calcium Phosphate, Tetra-Calcium Phosphate, Calcium Hydrogen Phosphate and Hydroxyapatite. This paste harden in 10 minutes and its stiffness increases to 80Mpa in 3days. Cementless THA were performed in 45 osteoarthritic hips from 1999 to 2002. Eight of 40 patients were male and 32 were female, average age were 62.4 years old ranged 43 to 81. In 11 hips, CPP (10–12g) were filled as a femoral canal filler around the distal end of stem. In 34 hips, as a control, no CPP were filled in the canal. Proximal part of the stem was HA coated on rough metal surface. No thigh pain were observed in CPP group patients. In control group, five hips (14.7%) showed thigh pain (p< 0.05), but walking disability and pain were mild in the first year and improved by the next year. CPP filled in the canal were absorbed slowly on X-ray film, but prevention of thigh pain lasts for long time maximum 3 years. No infections and pulmonary embolism were observed in both series. Filling CPP into the gap between stem tip and femoral canal is useful technique to prevent thigh pain after cementless THA

Conventional wisdom holds that aseptic failure of proximal ingrowth femoral stems should be addressed by revision to a longer femoral stem dependent upon more distal fixation. This is a reliable and time-honoured strategy with a high likelihood of success provided secure initial fixation of the revision stem is obtained. Yet, stems reliant upon more distal diaphyseal fixation are accompanied by a greater risk of physiologic thigh pain attributable to the differential in flexural stiffness of the femoral shaft compared with the prosthetic stem. Contemporary proximal ingrowth femoral stems have become the most popular device used in total hip arthroplasty and are traditionally reserved for primary procedures. Nevertheless, the flat tapered design offers a tight fit between the medial and lateral endosteal cortices of the femur, unimpeded by an increasing anteroposterior dimension of the stem, and provides a secure geometrical block to rotational movement of the stem. In instances when the primary stem is not fit to the endosteal cortex on the anteroposterior radiograph, such as with the Corail or SROM devices, the opportunity may exist for revision with a flat tapered proximal ingrowth stem that is upsized to abut the endosteal femoral cortex. Such a strategy preserves the diaphyseal femur for subsequent revision in these typically young patients and avoids the issue of thigh pain in this active population. Likewise, revision of a well-fixed long stem that is associated with unrelenting thigh pain may be similarly accomplished by revision to a flat proximal ingrowth stem provided the integrity of the upper femur can be maintained during the revision. A prophylactic cerclage wire around the proximal femur is a helpful adjunct when using flat tapered proximal ingrowth stems in the revision setting

INTRODUCTION:. Short femoral stems are receiving increasing attention for less invasive total hip replacement (THR). The purpose of this study is to report our initial experience with a short modular femoral (SMF) stem at a minimum two-year follow up. METHODS:. Twenty-six primary total hip arthroplasties (THAs) using the SMF stem were performed between August 2009 and January 2010. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically up to two years. Radiographs were analyzed to determine the degree of stem migration from its initial postoperative position. These parameters were compared to those of a cohort of 54 patients implanted with a monolithic tapered wedge stem from the same manufacturer over the same time period. RESULTS:. There were three early revisions of the femoral component for thigh pain in the SMF group, and one revision for CoCr allergy, with improvement in HHS from 60 to 89. Radiographically, 20 of 26 stems (76%) migrated into varus in the first six weeks. Of these, eight patients (29.6%) reported moderate to severe thigh pain. Radiographic evidence of isolated lateral cortical hypertrophy at the stem tip was seen in 46% of study patients, and evidence of osteointegration was seen in all cases by one year. Between one and two years post op the pain had resolved in four patients not revised. It was persistent in one patient. Comparative analysis with the control group demonstrated no significant difference in stem subsidence, but a significantly greater varus shift in coronal-plane angulation (Mean 4.3°, SD 3.8° vs. Mean 1.0°, SD 1.1°; p < 0.0001). Mean HHS was lower in the SMF group (85.2 vs. 91.4; p < 0.01) at last follow up. DISCUSSION AND CONCLUSION:. The SMF stem demonstrated a tendency towards migration into a varus position where the lateral stem touches the lateral cortex of the femur, with resulting relatively higher incidence of thigh pain and early aseptic revision

Thigh pain and periprosthetic osteolysis associated with the femoral stem, is a common complication of cementless total hip arthroplasty. Treatment of this disabling complication is difficult but usually requires revision of the femoral stem, which is a procedure not without further morbidity. We describe a solution which does not require revision and which brought about resolution of the thigh pain. The patient was a 79 year old male who had a primary Total hip replacement (year 1998),This was revised (early 2001) to an uncemented cup (ABG type) and uncemented femoral component (Link MP stem) . He continued to experience disabling thigh pain which limited walking to only a few yards.The pain was thought to be related to concomitant paget’s disease in the Right hemipelvis and proximal femur. Rheumatology assessment and treatment with IV Pamidronate (three courses of treatment) did not produce any relief of pain and indicated a mechanical prosthesis related cause of pain. Radiology assessment was also indicating the same with osteolysis at the tip of the prosthesis. The patient did not want a further revision procedure, but wanted relief of pain.Therfore sufgicsl intervention to treat the osteolysis with allograft ground bone introdued retrogradely via an anterior knee approach with an intercondylar pilot hole and initial supracondylar reaming. Allograft was introduced using a 5 ml syringe and impacted with a 1 cm diameter metal rod. 50 ml of ground bone was introduced and impacted forcibly with rod and hammer impaction. The knee wound was closed in layers over 2 drains and post-op management was same as for total knee replacement, CPM and active NWB mobilization for six weeks followed by PWB, progressing to full weight bearing mobilization. Walking was free of thigh pain and walking distance was improved

Thigh pain appears often after THA used of the cement-less femoral components, but the appearance mechanism of thigh pain does not have been elucidated. As one factor of manifestation of thigh pain, it has been guessed that the pressure from the inside of medullary cavity of bone by the stem. The purpose of this study is confirming whether the flexor reflex is caused, by using the femur of a rabbit that applied the pressure from the inside of medullary cavity of bone. Japanese white rabbits with weight of about 3kg were used. Evaluation of the appearance of the pain by the pressure was performed by measurement of the hind leg flexor activity produced by the flexor reflex. After confirming that appearance of the muscles activity by the pain reflex from adding the pain stimulus to the hind leg skin of rabbits, we loaded of the pressure into the inside of medullary cavity of bone and observed whether the muscles activity appears. As the laboratory animals model, we prepared two kinds of rabbits by the difference in the amount of reaming. And we tested how the differences show up between these two kinds of rabbits. In the rabbits with few amounts of reaming, the flexor reflex appeared in low pressure. But, in the rabbits with many amounts of reaming, the flexor reflex did not appear in high pressure, either. It is known that the somatic sensory nerves are distributed in the bone, and it is known that the sensory nerve ends exist in the medullary cavity of bone. It was suggested that the pain is induced, when the sensory nerve ends remained in the inside of medullary cavity of bone and the pressure in whicha reaction is possible was carried out there

Controversy continues to exist regarding the choice of a cementless femoral component in a primary total hip arthroplasty. Both proximally coated tapered stems and fully coated cylindrical stems have excellent clinical results. The incidence of both thigh pain and proximal femoral stress shielding and multiple validated outcome measures were evaluated in a prospective randomized clinical trial with a minimum of two year follow-up comparing a proximally coated tapered femoral stem to a fully coated cylindrical femoral stem. A prospective randomized clinical trial (RCT) was performed comparing a cylindrical cobalt chrome fully coated femoral stem (Prodigy, Depuy, Warsaw, IN) to a tapered, titanium, proximally porous coated stem (Synergy, Smith & Nephew,. Memphis, TN) with respect to thigh pain, femoral stress shielding and multiple outcome measures. One hundred and ninety-four patients were enrolled and evaluations were performed pre-operatively, three months, six months and annually. Multiple outcome measures (Harris Hip Score, SF12, WOMAC, Patient Satisfaction Questionnaire, Thigh Pain Questionnaire) were obtained. Sixty-one of these patients were randomized to receive a bone density scan pre-operatively, two weeks post-operatively, six months and annually. Twelve patients were unavailable for two-year follow-up, leaving one hundred and eighty-two patients evaluated. No significant differences were demonstrated in thigh pain incidence or the multiple outcome measures. Bone density scans demonstrated significantly greater bone density (p< 0.005) in the tapered stem versus the cylindrical stem patients at two-week evaluations from distal femoral reaming. Both stem designs demonstrated statistically significant bone loss in Gruen zones one, six, seven between the two-week and one and two-year evaluations. There were no differences between stem designs although the Prodigy stem demonstrated trends towards greater bone loss in Gruen zones six and seven. This prospective RCT demonstrated no difference in thigh pain incidence and multiple outcome measures between patients receiving a proximally coated tapered versus a fully coated cylindrical femoral component. Both stem designs demonstrated statistically significant proximal femoral bone loss between the post-operative and two-year evaluations; however, there were no differences between stem designs

Aims: To review the results and clinical performance of the Anthropometric Total Hip (ATH) with line to line broaching. Methods: 70 press þt titaniumalloy double-wedge taper (136 to 213 mm [mean, 187 mm]) extensively coated grit-blasted (RA=12.0μ) stem prostheses were implanted in 67 patients. There were 29 primary THA, 33 conversions of surface replacements, 6 revision THA and 2 conversions of Hemi-Surface Replacements. The mean age was 55.8 years (range, 20 to 77 years). There were 34 males and 33 females (3 bilateral). The initial etiology was OA (50%), ON (11%), DDH (23%), Post- Trauma (4%), SCFE (2%), Rheumatoid (2%), and Ç other È (8%).Results: The mean follow-up time was 4.7 years (Range: 2–8). UCLA hip scores improved for Pain, Walking, Function, and Activity from 4.8, 6.0, 5.5, and 4.5 pre-operatively to 9.2, 8.3, 7.9, and 5.9 post-operatively. ROM was also comparable to cemented THA results. There were no intra operative fractures. One patient had a bicycling accident, fractured his femoral shaft which healed without surgery. Solid biologic þxation (Ç osseointegration È) was achieved in 100% with the grit-blasted stem. Conclusions: This early investigation shows excellent clinical results, and none of the patients reported any thigh pain. Intra-operative fractures were eliminated with line to line broaching. Our results demonstrate that thigh pain with cementless THA can be essentially eliminated with a titanium-alloy stem and a gentle double-wedge taper geometry. Extensive Ç osseointegration È suggests potential for long term durability

OBJECTIVE OF THE STUDY. The objective of this study is to establish the medium-term clinical and radiological results with the cementless three-dimensional Vektor-Titan stem compared with conventional cementless stem, such as PerFix stem. The latter stem has a double-wedge design with a rounded distal portion for canal filling (Fig. 1). MATERIALS AND METHODS. From July, 2004, to May, 2010, fifty seven Vektor-Titan stems and 150 PerFix stems were implanted for the patients with osteoarthritis, avascular necrosis, femoral neck fracture, and rheumatoid arthritis in our hospital. The results were evaluated clinically using Japanese Orthopedic Association (JOA) scores and the Merle d’Aubigne and Postel (M&P) scores. Radiographs were analyzed retrospectively. The criteria used for determining loosening were migration or a total radiolucent zone between the prosthesis/bone cement and host bone, wherein the width increased progressively or change of position, i.e., migration or subsidence of the prosthesis. Migration of the socket seen on the radiograph was defined as either the presence of a ≥2-mm position change or rotation. Position changes of the stem seen on the radiograph were defined as the presence of a progressive subsidence of ≥2 mm or change of position, e.g., varus or valgus. The follow-up period was 9.2 ± 2.6 (range, 5.0–14.0) years. RESULTS. One patient had intraoperative femoral shaft fracture and healed by conservative treatment. The mean JOA and M&P scores improved from preoperative 39.3 and 6.8 points to postoperative 90.9 and 17.2 points, respectively. Thigh pain was less frequent for Vektor-Titan stems (Table 1). Radiolucent lines was far less likely to appear for Vektor-Titan stems evaluated by Gruen's zonal analyses (Table 2). On the other hand, there were radiolucent zones of more than 90% in zone 4 with cementless PerFix stems (Table 2). There was no cases of loosening or postoperative infection. Although signs of bone atrophy were found in the proximal femur and the trochanters in 66.7 % of all cases, bone structure was radiologically normal without stress shielding in most cases (Table 2). On the contrary, there was evidence of an even denser bone structure, such as trabeculae, at the tip of the stem and the lateral implant fixation within the greater trochanter in Vektor-Titan stem cases. These findings remained unchanged over observation periods. DISCUSSION AND CONCLUSIONS. The cementless Vektor-Titan stem is made of Ti6AI7Nb, has got the shape of a straight three-dimensional cone. It has a high proximal volume in the form of a three-dimensional taper with longitudinal ribs. This design achieves strong primary fixation in the proximal metaphysis. Radiologically, newly formed trabeculae toward to the stem were indicative of direct biological fixation at the bone-implant interface. Medium-term results with the cementless Vektor-Titan stem show no implant loosening with stable metaphyseal fixation and preservation of bone structure in the proximal femur and the absence of radiolucent zones around the stem compared with conventional cementless stem

Abstract. Background. The use of tourniquet in knee arthroplasty is common but in recent times, it has initiated a debate on its use. Complications from use of tourniquet are well documented in literature but there is less evidence on thigh pain, blood loss and length of stay post arthroplasty. Methods. We included 62 patients undergoing knee arthroplasty either Unicondylar knee arthroplasty or total knee arthroplasty. Patients were allocated randomly in tourniquet and without tourniquet groups. Half of the patients had UKA and other half TKA. Thigh pain was recorded using Visual analogue scale on day 1, 2 and on discharge. A drop in pre-operative and post operative haemoglobin level was recorded too. Independent sample t-test was done to compare the difference between the 2 groups mainly, drop in haemoglobin, thigh pain, knee pain and length of stay. Results. The mean drop in haemoglobin was comparable and was not statistically significant. Thigh pain on day 1 in no tourniquet group had a mean value of 0 and statistically significant difference in thigh pain at day 1,2 and discharge. In subgroup analysis between TKA and UKA the latter had improved results. Conclusions. Knee arthroplasty surgery without the use of tourniquet provides less thigh pain in the post-operative period and there isn't any significant difference in post op haemoglobin drop. None of the patient required any blood transfusion. A trend of early discharge was noted too but probably due to sample size, it wasn't statistically significant

The Thompson hemiarthroplasty is a common treatment option for acute neck of femur fractures in the elderly population. Our department noted a significant number of patients returning with thigh pain, radiographic loosening and femoral osteolysis following cemented implantation of the titanium alloy version of the Thompson hemiarthroplasty. We are not aware of any previous reports documenting complications specific to the titanium Thompson implant and a retrospective cohort study was therefore initiated following clinical governance approval. 366 titanium alloy Thompson prostheses were implanted for hip fracture treatment between 2017 and 2020. As of February 2023, 6 of these have been revised at our hospital. 5 were revised for symptomatic femoral osteolysis and 1 presented with an acute periprosthetic fracture. All revised cases were determined to be aseptic. 32 living patients were excluded from recall on compassionate grounds due to permanent nursing home residence. 47 living patients were identified of which 33 attended for xray. 28 deceased and/or nursing home resident patients who had pelvis x-rays in the previous 12 months were also included in the analysis. Including the 6 index hips already revised, a total of 61 hip xrays were analysed, of which 19 hips (31.1%) showed radiographic evidence of femoral osteolysis or loosening. We conclude that there is a concerning incidence of femoral osteolysis and implant loosening associated with the titanium Thompson implant. We have discontinued use of the implant and reported our experience to the MHRA. We encourage other Scottish Health-Boards who use this implant to consider enhanced follow-up

Aims. There are concerns regarding initial stability and early periprosthetic fractures in cementless hip arthroplasty using short stems. This study aimed to investigate stress on the cortical bone around the stem and micromotions between the stem and cortical bone according to femoral stem length and positioning. Methods. In total, 12 femoral finite element models (FEMs) were constructed and tested in walking and stair-climbing. Femoral stems of three different lengths and two different positions were simulated, assuming press-fit fixation within each FEM. Stress on the cortical bone and micromotions between the stem and bone were measured in each condition. Results. Stress concentration was observed on the medial and lateral interfaces between the cortical bone and stem. With neutral stem insertion, mean stress over a region of interest was greater at the medial than lateral interface regardless of stem length, which increased as the stem shortened. Mean stress increased in the varus-inserted stems compared to the stems inserted neutrally, especially at the lateral interface in contact with the stem tip. The maximum stress was observed at the lateral interface in a varus-inserted short stem. All mean stresses were greater in stair-climbing condition than walking. Each micromotion was also greater in shorter stems and varus-inserted stems, and in stair-climbing condition. Conclusion. The stem should be inserted neutrally and stair-climbing movement should be avoided in the early postoperative period, in order to preserve early stability and reduce the possibility of thigh pain, especially when using a shorter stem. Cite this article: Bone Joint Res 2021;10(4):250–258

Clinical success of prostheses in joint arthroplasty is ultimately determined by survivorship and patient satisfaction. The purpose of this study was to compare (non-inferiority) a new morphometric designed stem for total hip arthroplasty (THA) against an established comparator. A prospective randomised multi-centre study of 144 primary cementless THA performed by nine experienced orthopaedic surgeons was completed (70 received a fully coated collarless tapered stem and 74 received a morphometric designed proximally coated tapered stem). PROMs and blood serum markers were assessed preoperatively and at intervals up to 2-years postoperatively. In addition, measures of femoral stem fit, fill and subsidence at 2-years post-operatively were measured from radiographs by three observers, with an intra-class correlation coefficient of 0.918. A mixed effects model was employed to compare the two prosthesis over the study period. A p-value <0.05 was considered statistically significant. Demographics, Dorr types and blood serum markers were similar between groups. Both stems demonstrated a significant improvement in PROMs between the pre- and post-operative measurements, with no difference at any timepoint (p > 0.05). The fully coated tapered collarless femoral stem had a non-significantly higher intra-operative femoral fracture rate (5.8% vs 1.4%, p = 0.24), with all patients treated with cable fixation and partial weight bearing. The mean subsidence at 2-years was 2.5mm +/- 2.3mm for the morphometric stem and 2.4mm +/- 1.8mm for the fully coated tapered collarless femoral stem (p = 0.879). There was one outlier in each group with increased subsidence (fully coated tapered collarless femoral stem 6.9mm, morphometric wedge stem 7.4mm), with both patients reporting thigh pain at 2 years. When compared with an established stem, the newer designed morphometric wedge stem performed well with comparable radiological and PROM outcomes at 2 year follow up. Continued follow-up is required for long term benchmarking

Clinical success of prostheses in joint arthroplasty is ultimately determined by survivorship and patient satisfaction. The purpose of this study was to compare (non-inferiority) a new morphometric designed stem for total hip arthroplasty (THA) against an established comparator. A prospective randomised multi-centre study of 144 primary cementless THA performed by nine experienced orthopaedic surgeons was completed (70 received a fully coated collarless tapered stem and 70 received a morphometric designed proximally coated tapered stem). PROMs and blood serum markers were assessed preoperatively and at intervals up to 2-years postoperatively. In addition, measures of femoral stem fit, fill and subsidence at 2-years post-operatively were measured from radiographs by three observers, with an intra-class correlation coefficient of 0.918. A mixed effects model was employed to compare the two prostheses over the study period. A p-value <0.05 was considered statistically significant. Demographics and Dorr types were similar between groups. Both stems demonstrated a significant improvement in PROMs between the pre- and post-operative measurements, with no difference at any timepoint (p > 0.05). The fully coated tapered collarless femoral stem had a non-significantly higher intra-operative femoral fracture rate (5.8% vs 1.4%, p = 0.24), with all patients treated with cable fixation and partial weight bearing. The mean subsidence at 2-years was 2.5mm +/- 2.3mm for the morphometric stem and 2.4mm +/- 1.8mm for the fully coated tapered collarless femoral stem (p = 0.879). There was one outlier in each group with increased subsidence (fully coated tapered collarless femoral stem 6.9mm, morphometric wedge stem 7.4mm), with both patients reporting thigh pain at 2 years. When compared with an established stem, the newer designed morphometric wedge stem performed well with comparable radiological and PROM outcomes at 2 year follow up. Continued follow-up is required for long term benchmarking

Abstract. Extended Trochanteric Osteotomy (ETO) improves surgical exposure and aids femoral stem and bone cement removal in Revision Total Hip Replacement (RTHR) surgery. The aim of this study was to identify healing rates and complications of ETO in RTHR. Methods. From 2012 to 2019 we identified patients who underwent ETO for RTHR. Data collected demographics, BMI, diabetes, anticoagulants, indication for ETO, surgical approach, length of ETO and complications. Descriptive analysis of patient demographics, multiple linear regression analysis was performed to assess ETO complications. Results. There were 63 patients with an average age of 69 years. Indications for ETO were aseptic loosening (30), infection (15), periprosthetic fracture (9), recurrent dislocation (5), broken implant (4). There were 44 cemented and 19 uncemented femoral stem that underwent ETO. Average time from index surgery was 12 years (less than a year to 38 years). All procedures were through posterolateral approach and all ETO were stabilised with cables. Average length of ETO was 12.5cm. BMI varied from 18 to 37. There were 5 diabetics and 16 on anticoagulants. All but one ETO went on to unite. Other complications included infection, dislocations, lateral thigh pain and significant limp. Discussion. Fixation of ETO can be with either wires or cables or plate with cables/screws. Advantages of cables are no irritation over greater trochanter, no disruption of gluteus medius/vastus lateralis continuity, reproducible tension in cables and use of torque limiter minimises loss of tension in cables

In recent years, cementless stems have dominated the North American market. There are several categories of cementless stems, but in the past 20 years, the two most popular designs in the United States have been the extensively coated cylindrical cobalt-chrome (CoCr) stem and the proximally coated tapered titanium stem, which in recent years has become the most common. The 10-year survival for both stem types has been over 95% with a distinction made on factors other than stem survival, including thigh pain, stress shielding, complications of insertion, and ease of revision. Conventional wisdom holds that proximally coated titanium stems have less stress shielding, less thigh pain, and a higher quality clinical result. Recent studies, however, including randomised clinical trials have found that the incidence of thigh pain and clinical result is essentially equivalent between the stem types, however, there is a modest advantage in terms of stress shielding for a tapered titanium stem over an extensively coated CoCr stem. One study utilizing pain drawings did establish that if a CoCr cylindrical stem was utilised, superior clinical results in terms of pain score and pain drawings were obtained with a fully coated versus a proximally coated stem. In spite of the lack of a clinically proven advantage in randomised trials, tapered titanium stems have been favored because of the occasional occurrence of substantial stress shielding, the increased clinical observation of thigh pain severe enough to warrant surgical intervention, ease of use of shorter tapered stems that involve removal of less trochanteric bone and less risk of fracture both at the trochanter and the diaphysis due to the shorter, and greater ease of insertion through more limited approaches, especially anterior approaches. When tapered stems are utilised, there may be an advantage to a more rectangular stem cross-section in patients with type C bone. In spite of the numerous clinical advantages of tapered titanium stems, there still remains a role for more extensively coated cylindrical stems in patients that have had prior surgery of the proximal femur, particularly for a hip fracture, which makes proximal fixation, ingrowth, and immediate mechanical stability difficult to assure consistently. Cement fixation should also be considered in these cases. While the marketplace and the clinical evidence strongly support routine use of tapered titanium proximally coated relatively short stems with angled rather than straight proximal lateral geometry in the vast majority of cases, there still remains a role for more extensively coated cylindrical and for specific indications

Cementless distally locked stems were introduced in revision hip arthroplasty (RTHA) in the late 1980s to deal with severe femoral bone loss. These implants have not been assessed over the long-term, particularly the influence of the design and porous coating. Therefore we performed a retrospective case-control study at a minimum 10-years' follow-up comparing the straight Ultime™ stem with 1/3 porous coating versus the anatomical Linea™ stem with 2/3 proximal coating with hydroxyapatite. We performed a single-center case-control study measuring survival, function based the Harris and Oxford-12 scores, and rate of thigh pain. X-rays were done at regular intervals and at follow-up. No femoral bone graft was used at insertion. The two groups were comparable in terms of age, sex and follow-up (mean 12.2 years in Ultime and 10.8 years in Linea cohorts); however they differed in the severity of bone loss therefore the results were adjusted according to this variable. Ten-year survival considering revision for any reason was 63.5% ± 5.4 for Ultime and 91.6% ± 2.7 for Linea (p < 0.001). Merle d'Aubigné scores and Oxford-12 were higher in the Linea group 82.9 ± 12.4 and 26.3/48, respectively, versus 69.5 ± 16 and 21/48 in the Ultime group (p < 0.001). Thigh pain was observed in 30% of Ultime cases versus 3% of Linea cases. Bone reconstruction measured via cortical thickness was better in the Linea group and correlated to metaphyseal filling at insertion. This study confirms the benefits of using of locked stems in RTHA with severe bone loss. Better metaphyseal filling and optimized porous coating help to minimize thigh pain and the revision rate

This study used model-based radiostereometric analysis (MBRSA) to compare migration of a recently introduced cementless hip stem to an established hip stem of similar design. Novel design features of the newer hip stem included a greater thickness of hydroxyapatite coating and a blended compaction extraction femoral broach. Fifty-seven patients requiring primary total hip arthroplasty (THA) were enrolled at a single centre. Patients were randomized to receive either an Avenir collarless stem and Trilogy IT cup (ZimmerBiomet) or a Corail collarless stem and Pinnacle cup (DePuy Synthes) via a posterior or lateral approach. Both stems are broach-only femoral bone preparation. RSA beads (Halifax Biomedical) were inserted into the proximal femur during surgery. Patients underwent supine RSA imaging a 6 weeks (baseline), 6, 12, and 24 months following surgery. The primary study outcome was total subsidence of the hip stem from baseline to 24 months as well as progression of subsidence between 12 and 24 months. These values were compared against published migration thresholds for well-performing hip stems (0.5mm). The detection limit, or precision, of MBRSA was calculated based on duplicate examinations taken at baseline. Patient reported outcome measures were collected throughout the study and included the Oxford-12 Hip Score (OHS), EuroQoL EQ-5D-5L, Hip Osteoarthritis Score (HOOS) as well as visual analogue scales (VAS) for thigh pain and satisfaction. Analysis comprised of paired and unpaired t-tests with significance set at p≤0.05. Forty-eight patients (30 males) were included for analysis; 7 patients received a non-study hip stem intra-operatively, 1 patient suffered a traumatic dislocation within three weeks of surgery, and 1 patient died within 12 months post-surgery. RSA data was obtained for 45 patients as three patients did not receive RSA beads intra-operatively. Our patient cohort had a mean age of 65.9 years (±;7.2) at the time of surgery and body mass index of 30.5 kg/m2 (±;5.2). No statistical difference in total stem migration was found between the Avenir and Corail stems at 12 months (p=0.045, 95%CI: −0.046 to 0.088) and 24 months (p=0.936, 95% CI: −0.098 to 0.090). Progression of subsidence from 12-24 months was 0.011mm and 0.034mm for the Avenir and Corail groups which were not statistically different (p=0.163, 95%CI: −0.100 to 0.008) between groups and significantly less than the 0.5mm threshold (pNo statistically significant differences existed between study groups for any pre-operative function scores (p>0.05). All patients showed significant functional improvement from pre- to post-surgery and no outcome measures were different between study groups with exception of EQ-5D-5L health visual analogue scale at 12 months which showed marginally superior (p=0.036) scores in the Avenir group. This study was not powered to detect differences in clinical outcomes. This study has demonstrated no statistical difference in subsidence or patient-reported outcomes between the Corail hip stem and the more recently introduced Avenir hip stem. This result is predictable as both stems are of a triple-tapered design, are coated with hydroxyapatite, and utilize a broach-only bone preparation technique. Both stem designs demonstrate migration below 0.5mm suggesting both are low-risk for aseptic loosening in the long-term