Diagnosis of and Early Revision Surgery for Biological Fixation Failure Due to Proximal-Distal Mismatch of Proximally Coated Tapered Cementless Stem

Abstract

The diagnosis of and decision-making for early revision surgery to treat failure of biological fixation with a proximally coated cementless stem are challenging. A 73-year-old woman was referred to our hospital with thigh pain 2 years after the initial total hip arthroplasty. Although a plain radiograph showed no signs indicating biological fixation failure, digital tomosynthesis showed a highly radiodense line along the proximal part, and bone scintigraphy showed uptake at the distal part. With the diagnosis of biological fixation failure due to the proximal-distal mismatch, the cementless stem was revised to a cemented stem, and the thigh pain was improved after the revision surgery. Digital tomosynthesis and bone scintigraphy can be helpful for the diagnosis of biological fixation failure due to proximal-distal mismatch.

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

“…In addition, an overhanging prominent ilium may generate an unintended rotation during the rasping process and a suboptimal metaphyseal preparation. While some axial stability might be achieved by virtue of the tight canal, micromotion in the metaphysis may result in the failure of osseointegration [32,33]. A flat metaphyseal wedge stem design, such as the one used in the present study, is likely poorly tolerant of this lack of osseous support in the anteroposterior plane.…”