Early Clinico-Radiographic Outcomes of Cementless Collared Triple Taper Stems in Osteoporotic Patients Undergoing Elective Total Hip Arthroplasty: A Descriptive Analysis
Aug 2026· Arthroplasty Today· Vol 40· 0 citations· 24 references
Medicine
TL;DR
Cementless CTTS demonstrated reliable early fixation with no femoral failures in a rigorously defined osteoporotic cohort, suggesting that cementless CTTS may be a viable option for femoral fixation in osteoporotic patients undergoing elective THA.
Abstract
Background Osteoporosis is a well-established risk factor for early femoral failure following cementless total hip arthroplasty (THA). The performance of cementless collared triple-taper stems (CTTSs) in patients with a confirmed diagnosis of osteoporosis remains poorly defined. This study aimed to evaluate early clinico-radiographic outcomes of CTTS in osteoporotic patients undergoing elective THA. Methods We retrospectively reviewed 96 patients (87.5% women; mean age 69.5 ± 7.4 years) who underwent elective THA with a CTTS between 2018 and 2025. Osteoporosis was confirmed by either dual-energy x-ray absorptiometry T-score ≤ −2.5 or history of fragility fracture. Preoperative morphology and postoperative canal fill ratios, alignment, and subsidence (>3 mm) were assessed. Femoral failure was defined as periprosthetic fracture or aseptic loosening. Results Preoperative morphology demonstrated a predominance of wide canals (Dorr B: 67.5%, Dorr C: 26%) and a mean morphological cortical index of 2.55. Postoperatively, high mean canal fill ratios were achieved (Z1: 0.66; Z2: 0.79; Z3: 0.76; Z4: 0.74), indicating reliable metaphyseal and diaphyseal fit. Despite osteoporotic bone quality, no cases of measurable subsidence were observed. Prominent collars occurred in 34.4% and neocortex formation in 5.2%, with no associated complications. At a mean follow-up of 2 years (range 1–7), the primary outcome of femoral failure was 0% at 90 days, 1 year, and final follow-up. Conclusions Cementless CTTS demonstrated reliable early fixation with no femoral failures in a rigorously defined osteoporotic cohort. These findings suggest that cementless CTTS may be a viable option for femoral fixation in osteoporotic patients undergoing elective THA. Level of Evidence Level III, Therapeutic study.
Introduction
Osteoporosis may adversely affect implant fixation and bone integrity following total elbow arthroplasty (TEA), yet its impact on postoperative complications remains incompletely defined. This study compared outcomes following TEA in patients with and without osteoporosis.
Methods
A retrospective analysis was performed including 1,410 adult patients who underwent total elbow arthroplasty (TEA) with a minimum follow-up of two years. Patients with osteoporosis were matched to an equal number of patients without osteoporosis based on demographics, comorbidities, surgical indication, and preoperative inflammatory laboratory markers. Outcome measures included two-year rates of revision, periprosthetic fracture, implant loosening, prosthetic joint infection (PJI), ulnar nerve injury, and instability. A secondary analysis of 520 patients with osteoporosis compared those who received anti-osteoporosis medication to those who did not. Complication rates were compared between groups using chi-squared testing.
Results
Patients with osteoporosis had higher two-year rates of periprosthetic fracture (4.4% vs. 1.4%, p<0.001) and implant loosening (5.0% vs. 2.3%, p=0.007). There were no differences in revision (p=0.144), PJI (p=0.479), ulnar nerve injury (p=0.228), or instability (p=0.692). Among patients with osteoporosis, medication use was not associated with differences in revision, implant loosening, PJI, or ulnar nerve injury. Patients on medication had a lower rate of periprosthetic fracture that did not reach significance (p=0.061).
Conclusion
Osteoporosis is associated with increased risk of periprosthetic fracture and implant loosening following TEA. These findings suggest that impaired bone quality may contribute to structural modes of failure, highlighting the importance of preoperative bone health optimization in patients undergoing TEA.
Akinkunmi Adio, M. Daher, J. Alsamhori et al.· Geriatric Orthopaedic Surger...· 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
The management of severe acetabular bone defects remains challengin due to extensive bone loss and poor soft tissue quality during revision total hip arthroplasty (rTHA). The aim of this study was to assess clinical and radiological outcomes of the use of dual mobility components (DMC) cemented into a newly implanted porous tantalum (PT) acetabular shell during acetabular rTHA. Patients who underwent cementation of a DMC into a newly implanted PT cup between 2014 and 2020 were included. Bone defects were classified according to the Paprosky classification. The primary outcome was to determine the reintervention-free survival rate. The secondary outcome was clinical and radiographic assessment at last follow-up. Thirty-six patients (36 hips), with an average age of 67.9 years (range, 46–90) were included. Paprosky type III defects (61.1%) were more common than type II defects (38.9%), with type IIIa (36.1%) and IIIb (25.0%) predominating. Median follow-up was 67.3 months (range; 17–109). The dislocation rate was 8.3% (n = 3). Four (11.1%) of 36 hips underwent acetabular component revision: 2 (5.5%) for infections, 1 (2.7%) for aseptic loosening, and 1 (2.7%) for dislocation. Cup survival rate was 89.08% (CI 69.54% to 96.38%) at 60 months. The Harris hip score (HHS) improved from 31.8 ± 12.0 to 87.0 ± 14.2 points (p < 0.001). The vertical and horizontal position of the hip center of rotation (COR) improved from 19.4 ± 14.9 mm to 3.8 ± 3.4 mm and from 12.4 ± 9.9 mm to 3.8 ± 3.5 mm, respectively (both p < 0.001). Limb length discrepancy improved from − 7.8 ± 20.6 mm to -1.7 ± 5.6 mm (p = 0.056). DMCs cemented into PT shells could be considered an effective management of severe acetabular bone defects without pelvic discontinuity providing excellent clinical and radiographic results in the mid-term.
M. Loppini, V. Di Matteo, Alberto Bulgarelli et al.· Archives of Orthopaedic and...· 0 citations
Background and purpose Periprosthetic bone may influence the longevity of joint implants. We aimed to investigate the association between bone mineral density (BMD) and tibial implant migration of cemented and cementless knee arthroplasty as a surrogate marker of aseptic loosening. Methods In a prospective cohort study, patients were operated on between 2014 and 2018 with a unicompartmental knee arthroplasty (UKA) or a total knee arthroplasty (TKA). Preoperative BMD was measured using dual-energy X-ray absorptiometry of the lumbar spine and hips. Patients were categorized into low or normal T-score groups (threshold: T-score ≤ –1.0). Postoperative tibial implant migration was assessed using radiostereometry at baseline and 1-, 2-, and 5-year follow-ups. The primary outcome was 1-year maximum total point motion (MTPM) differences between T-score groups. Secondary outcomes evaluated the association between continuous migration (MTPM > 0.2 mm between 1 and 2 years) and T-score. Results 397 patients were included, where 210 patients received a cementless implant (TKA = 78, UKA = 132) and 187 received a cemented implant (TKA = 83, UKA =104). Estimated 1-year mean MTPM differences between the low and normal T-score groups were 0.15 mm (CI −0.25 to 0.55) for cementless TKA, 0.12 mm (CI −0.25 to 0.49) for cemented TKA, −0.21 mm (CI −0.51 to 0.10) for cementless UKA, and −0.15 mm (CI −0.34 to 0.04) for cemented UKA. A 1-unit increase in T-score showed comparable odds of continuous migration within both cemented (OR 0.94, CI 0.68–1.30) and cementless (OR 0.79, CI 0.56–1.12) tibial implants. Conclusion Tibial implant migration was not significantly different between patients with low and normal BMD as defined by T-score groups. These findings should be interpreted cautiously due to small group sizes and wide confidence intervals, highlighting the need for further studies to clarify the role of BMD in implant migration.
K. N. Linde, Bente L. Langdahl, S. Rytter et al.· Acta Orthopaedica· 0 citations
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
Aims
This randomized controlled trial (RCT) aimed to compare clinical and radiological outcomes of cemented acetabular component in primary total hip arthroplasty (THA) in patients aged under 60 years with and without autologous impaction bone grafting (IBG).
Methods
A single-centre, triple-blinded RCT was conducted in patients aged 18 to 59 years undergoing primary THA without acetabular defects. Patients were randomized to receive either IBG or no IBG. Noninferiority of IBG was assessed for the primary endpoint, the Hip disability and Osteoarthritis Outcome Score (HOOS) sub-scale for activities of daily living (ADL) at one-year follow-up. Secondary outcomes included other patient-reported outcome measures (PROMs), perioperative outcomes, complications, and radiological outcomes. Radiographs assessed acetabular component and centre of rotation positioning, offset changes, and the presence of radiolucent lines in the bone-cement interface.
Results
A total of 131 patients were randomized. No significant group differences were found for the HOOS-ADL sub-scale at one year (mean difference 1.9 points (95% CI -4.85 to 8.7); p = 0.578), meeting the criteria for noninferiority. Furthermore, there was no effect of group on the scores for other PROMs. Surgery duration (+ 7.5 minutes; p < 0.001) and blood loss (+ 100 ml; p = 0.001) were significantly higher in the IBG group. Complication and revision rates were comparable. Radiologically, the IBG group had significantly fewer radiolucent lines in the bone-cement interface than the control group at one-year follow-up (p < 0.001). Compared with preoperatively, the postoperative position of the centre of rotation was less superior and medial in the IBG group (p = 0.024).
Conclusion
The use of autologous IBG with a cemented acetabular component in primary THA in young patients is noninferior to standard cemented fixation regarding short-term clinical outcomes. IBG improves vertical position of the centre of rotation and early radiological fixation by reducing radiolucent lines around the cup, suggesting potential benefits for long-term acetabular component survival.
D. D. de Boer, P. Pasman, R. Munnik-Hagewoud et al.· The Bone & Joint Journal· 0 citations
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