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Introduction: Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component. Methods: We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years. Preoperative radiographs were used to assess femoral neck shaft angle (FNS), canal flare index (CFI), Dorr classification, and greater trochanter (GT) overhang. Postoperative radiographs were used to determine stem alignment and 6-week follow-up radiographs were used to determine subsidence. Clinical outcomes included thigh pain, leg-length discrepancy (LLD), patient-reported outcome measures (PROMs) and revision surgeries. Results: 271 stems (96%) did not subside (4 mm). Subsidence was significantly associated with subsequent revision surgery ( p Conclusions: Subsidence and proximal-femoral morphology are potential sources of postoperative morbidity in certain cementless THA patients. In accordance with prior studies, CFI was identified as a potential risk factor for intraoperative calcar fractures. More research into preoperative femoral morphologies, such as GT overhang and FNS, is warranted as these may contribute to unsatisfactory results related to cementless THA.

Background:Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome.Methods:123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29–89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy.Results:1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1–99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2–70), 18 (SD 12.1, range -10–43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy.Discussion:This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

Introduction Cement extrusions on the femoral side after total hip replacement can occur in approximately 0.3% of cemented primary total hip replacements. Not recognised until a postoperative x-ray is performed, the willingness to dismiss and treat these extrusions conservatively is high. Methods We report on 3 patients presenting with sudden onset of thigh pain associated with an inability to weight-bear after a 2 to 15 month period of uneventful healthy recovery from cemented total hip replacement. On immediate postoperative x-rays occult cement extrusion in the posterolateral circumference of the femoral component tip were present. X-rays and CT scans showed no fracture signs. Scintigraphy revealed late increased uptake at the extrusion height. With the hypothesis of imminent femoral fatigue fracture, all patients underwent revision surgery. The defect sites were surgically exposed, thoroughly cleaned of cement, filled with iliac crest bone graft and stabilised with tension band plating. Results This procedure resulted in fully recovered asymptomatic patients at 6 weeks and after a mean follow-up period of 48 months, as demonstrated by their pain level and tolerance of full weight bearing. Conclusions These cases lead us to adopt a low threshold for immediate revision when occult cement extrusion is recognised near the tip of a cemented stem on postoperative films, and to adopt a low threshold for surgical revision when, in the presence of cement extrusion, thigh pain is a complaint. We favour tension band plating and bone grafting over more complex implant revisions since a fast recovery was achieved in these patients.

Thigh pain after total hip arthroplasty can be a significant management problem both to patient and surgeon. In many cases, the pain is caused by femoral stem impingement due to its varus position. We present the technique of resection of a segment of distal femoral stem through a minimal incision as treatment of this problem. Five patients with a follow-up of 6 to 10 years are discussed. In all patients thigh pain was explained by the radiographic appearance of the varus stem position and reactive bone formation around the tip of the stem. A bone window was created and resection of the tip of the stem was performed. Four of the patients completely recovered after surgery and one patient, with Paget's disease, required additional interventions due to stress fracture. This is a very simple and effective method of treatment of thigh pain due to femoral stem impingement in healthy bone.

In the 1980s, uncemented prostheses were considered advantageous in younger patients. One of the prostheses used in Denmark was the Porous Coated Anatomic (PCA) prosthesis. Follow-up results from Aarhus University Hospital (AaUH) showed progressive osteolysis along the stem at five to seven years, and use of the prosthesis was no longer recommended.We used the PCA prosthesis with a modular 28mm head, and so far our results with patients operated on between 1989 and 1993 do not confirm the negative results published. Thirty-nine consecutive cases were followed prospectively with clinical and radiographic assessment.At the 8–12 year follow-up four patients had undergone revision. Three revisions were for aseptic loosening of the cup at 5, 10 and 12 years, and one was because of thigh pain without radiological signs of loosening at revision. The cumulative survival rate was 95% at five years, 92% at ten years and 85% at twelve years. If we include radiologically loose components, five cups were re-operated or radiographically loose (12.8%) and 4 stems were re-operated or radiographically loose (10.2%). Thus the survival rate at 12 years was 85% and 90% for cup and stem respectively. So far we have not experienced progressive radiographic changes.The difference in results may stem from the fact that we used 28mm heads (versus 32mm heads in the Aarhus series), which allows a more adequate polyethylene thickness and thereby lesser creep of the polyethylene and less polyethylene debris production.

Mid Thigh Pain (MTP), i.e. a continuous dull pain in the thigh present after prolonged weight-bearing, is a common experience in hip arthroplasties. Since its origin is not clear, the Authors try to explain its etiology and pathogenesis through an analysis of a selection of their cases and of the literature. MTP seems to be a signal of bone overloading at the interface with the prosthesis; the overloading causes biochemical changes in the fibrous tissue surrounding the femoral component, which, in turn, provokes a bone resorption enhancing movements and overloading. If not treated with unloading, MTP may result in stem loosening.