Abstract Introduction: Impaction bone grafting (IBG) with cemented stems in revision total hip arthroplasty (THA) is a well-established method, but reports using cementless stems are scarce. The purpose of this study is to report short-term outcomes of six revision THAs using the IBG technique with a collared fully hydroxyapatite (HA)-coated stem. Materials and Methods: From 2014 to 2021, six joints (median age 64.3 years; median follow-up 4.5 years) were revised for aseptic loosening (n = 5) or septic loosening (n = 1). All cases used the IBG technique with a collared fully HA-coated stem (CORAIL or UNIVERSIA). Full weight-bearing was allowed post-operative day 1. Outcomes included the Japanese Orthopedic Association Score, stem subsidence, and radiographic remodeling. Results: Median surgical time was 127 min; blood loss was 855 mL. No complications (infection, polyethylene wear, loosening, or dislocation) occurred. The JOA score improved from 63 (preoperatively) to 95 (final follow-up). Median stem subsidence was 1.4 mm (1–3 mm), with no case >5 mm. Radiographs showed no radiolucent lines and remodeling in all cases. Computed tomography (CT) images of one case confirmed bone ingrowth between the stem and the compressed allograft. Conclusion: Short-term outcomes of revision THA with IBG using a collared fully HA-coated stem are favorable. This technique, supported by radiographic and CT evidence of bone ingrowth, is a useful and effective treatment option for femoral component revision.
Takamitsu Sato, J. Nakamura, K. Oinuma et al.· Journal of Orthopaedic Case...· 0 citations
Early postoperative periprosthetic femoral fractures (PPFs) are serious complications after total hip arthroplasty (THA) that often require revision surgery. Although collared, fully hydroxyapatite-coated cementless stems have shown favorable clinical outcomes, limited data are available on the incidence of PPFs and stem subsidence after direct anterior approach THA using this stem design. Early fracture behavior and stem subsidence patterns in this setting remain clinically important. We investigated the incidence and clinical course of early postoperative PPF and stem subsidence after direct anterior approach THA using the UNIVERSIA stem.
We retrospectively reviewed 4,094 hips that underwent primary cementless THA between September 2020 and May 2024. PPFs within 1 year were stratified by the presence or absence of trauma. Stem subsidence ≥2 mm was assessed radiographically.
PPFs occurred in 16 hips (0.39%): eight non-traumatic fractures (0.20%) and eight traumatic fractures (0.20%). All non-traumatic fractures were successfully managed conservatively, whereas seven traumatic fractures (0.17%) required surgery. Stem subsidence ≥2 mm occurred in six hips (0.15%); one traumatic case required revision, and the remaining five stabilized within 3 weeks without further progression.
Early PPF and stem subsidence rates were low. Stratification by trauma mechanism may help identify fractures requiring surgery, whereas non-traumatic fractures and most subsidence cases were successfully managed non-operatively.
Case series; Level IV.
Hiroshige Hamada, Y. Miura, T. Ninomiya et al.· Journal of Orthopaedics· 0 citations
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