title: Preparation of the Femoral Bone Cavity for Cementless Stems: Broaching vs Compaction. A Five-Year Randomized Radiostereometric Analysis and Dual Energy X-Ray Absorption Study.
abstract: Short-term experimental and animal studies have confirmed superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone.
  
  
  
  Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery.
  
  
  
  Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12° (SD 0.13°) in the broaching group were less than mean 0.35° (0.45°) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery.
  
  
  
  We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems.
authors.affiliation: Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mette H
authors.initials: MH
authors.lastname: Hjorth
authors.affiliation: Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Kold
authors.affiliation: Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.affiliation: Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bente L
authors.initials: BL
authors.lastname: Langdahl
authors.affiliation: Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Poul T
authors.initials: PT
authors.lastname: Nielsen
authors.affiliation: Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Poul H
authors.initials: PH
authors.lastname: Christensen
authors.affiliation: Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Maiken
authors.initials: M
authors.lastname: Stilling
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015519:Bone Density; D017886:Durapatite; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D059869:Radiostereometric Analysis; D013997:Time Factors; D014965:X-Rays
chemical_list: D017886:Durapatite
keywords: broaching; cementless femoral stem; compaction; dual X-ray energy absorption; femoral bone preparation technique; radiostereometric analyses