title: Preparation of the femoral bone cavity in cementless stems: broaching versus compaction.
abstract: Background and purpose - Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. Patients and methods - 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36-70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0-9.5) years after surgery. Results - Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03-0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0-9.5) years after surgery. Interpretation - Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.
authors.affiliation: a Department of Orthopaedics , Aarhus University Hospital , Aarhus.
authors.forename: Mette H
authors.initials: MH
authors.lastname: Hjorth
authors.affiliation: a Department of Orthopaedics , Aarhus University Hospital , Aarhus.
authors.forename: Maiken
authors.initials: M
authors.lastname: Stilling
authors.affiliation: a Department of Orthopaedics , Aarhus University Hospital , Aarhus.
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.affiliation: b Department of Orthopaedics , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Poul Torben
authors.initials: PT
authors.lastname: Nielsen
authors.affiliation: b Department of Orthopaedics , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Poul H
authors.initials: PH
authors.lastname: Christensen
authors.affiliation: a Department of Orthopaedics , Aarhus University Hospital , Aarhus.
authors.forename: Søren
authors.initials: S
authors.lastname: Kold
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements; D015519:Bone Density; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000601:surgery*; D057068:Periprosthetic Fractures / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D059869:Radiostereometric Analysis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D001843:Bone Cements