25 patients in age group (25–40yrs), 15 males, 10 females were implanted with a short metaphyseal cementless stem (‘Proxima’®, Depuy) and cementless acetabular cup. The average follow up was 2.3 years (1.4–2.5 yrs). Clinical evaluation using Harris Hip Score, Radiological evaluation and Bone Mineral Density were evaluated at 2weeks, 6 months, 12 months and yearly thereafter. a new zonal method suitable for short stem was used for radiological evaluation. The mean Harris Hip score improved from 44 to 95 at final follow up. There was no evidence of any radiolucent lines or osteolysis around the stems. All the stems showed evidence of osseointegration at one year follow up. There was no decrease in bone mineral density around the stems. The Short Metaphyseal cementless femoral stem is a bone conserving as well as bone preserving option for young patients especially in those in whom surface replacement is not an option

Interestingly, recent studies have shown promising outcomes in elderly. To the best of our knowledge there are no reports available assessing sequential bone remodelling around DCPD (dicalcium phosphate dehydrate) coated short metaphyseal loading stem using serial radiography. Hence we report the unique patterns of bone remodelling in patients 70 years and older and whether these patterns were different from those seen in younger patients. A total of 41 consecutive primary hip arthroplasties were performed in patients with averaged age of 78.3 years using short stem. The presence and patterns of radiolucent lines, radio-opaque lines, calcar rounding, proximal bone resorption, spot welds, cortical hypertrophy, and intramedullary bone formation around the distal tip were assessed at serial radiography up to averaged follow up of 24.5 months. In early stage of stability, the radio-opaque line appeared in lateral aspect of stem which might means the tension force of stem. On the contrary to this findings, the medial side of stem mainly showed the spot welds due to compression on calcar support. The sequential radiographic bone remodelling in 70 years and older showed the different pattern from those of 30 to 50 year-old. Formation of new endosteal trabeculation (spot welds) were seen only in 55.6% of stems among the elderly study group where as all patients showed spot welds in the younger group. Calcar resorption was often observed in younger group but the degree of calcar resorption was less. The other findings in elderly patients was not different compared to those of younger patients

Purpose. Traditional total knee arthoplasty techniques have involved implantation of diaphyseal stems to aid in fixation expecially when using constrained polyethylene inserts. While the debate over cemented vs uncemented stems continues, the actual use of stems is considered routine. The authors' experience with cemented stemmed knee revisions in older patients with osteoporotic bone has been favorable. Our younger patients with press-fit stems from varying manufacturers have been plagued with a relatively high incidence of component loosening and stem tip pain in the tibia and occasionally thigh. We report the early results of the first 20 total knee revisions using press-fit metaphyseal filling sleeved stemless implants with constrained bearings. Methods. Twenty three patients with failed primary or revision total knees were assigned to receive stemless sleeved revision knee designs using the DePuy MBT/TC3 system. Reasons for revision included loosening, implant fracture, stiffness, instability, and stem pain. Twenty patients (ages ranging from 42–73) were successfully reconstructed without stems. Six knees with significant uncontained cavitary defects were included. Three patients with unexpectedly osteoporotic metaphyseal bone were revised with cemented stemmed implants and excluded. All cases used cement for initial fixation on the cut bone surface and fully constrained mobile bearing inserts. Results. Follow up ranged from six months to three years. All patients had radiographic evidence of well fixed stable implants on most recent examination. All four cases of revision for “end of stem pain” had complete resolution of symptoms within two weeks of revision surgery. Long leg anterior posterior mechanical alignment x-rays measured within two degrees of neutral in all cases. Knee Society Scores improved an average of 34 points. Clinical results for revision for stiffness had the lowest final scores post operatively. Conclusion. Stemmed total knee arthroplasty revision implants with or without cement are considered the standard for most revision reconstructions. Recently, primary total hip replacements using newer short metaphyseal stems have shown promising early clinical results. This case series of twenty total knee revisions using stemless press-fit metaphyseal sleeves shows similarly favorable outcomes. The complications of stemmed implants such as stem tip pain and difficulty of cemented stem removal can be avoided successfully in non-osteporotic bone reconstructions. With stable bony ingrowth visible on early post-operatyive radiographs, long term stable fixation even with constrained bearings is expected. Longer follow up will be needed to validate this technique for routine use