New cementless fixation in hip arthroplasty: a radiostereometric analysis (original) (raw)

fered the desired improvement partly due to polyethylene wear issues (7-11). Despite registry data indicating superior survivorship of cemented THRs, the use of cementless prostheses have been steadily rising. Experimental investigations show that canalfilling cementless metal stems are not uniformly stable at all contact areas with the femur under physiological loading (12, 13). Furthermore, cementless stems can result in more intense stress-shielding and higher shear loads, leading to increased micromotion at the bone-implant interface. If micromotion occurs before the bone-prosthesis interface is established through bone ingrowth or ongrowth to the implant, a fibrous layer develops, preventing solid anchorage of the prosthesis (14, 15). To prevent this from happening, the hip should be protected from overloading during the 12 to 16 week period necessary for the bone to remodel and provide solid support. However, most rehabilitation protocols typically include different isometric exercises, which result in hip loads similar to those recorded during normal gait (16, 17). As a result, stability of the majority of press-fit stems is jeopardised. Failure to preserve a stable bone-implant interface can lead to aseptic loosening of the stem resulting in pain and ultimately leading to revision.

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