Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting

Abstract

Purpose

Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique.

Methods

From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction.

Results

There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39).

Conclusions

Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes.

Australian clinical trial registration number

ACTRN12618000652279.

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Acknowledgements

DEXA imaging: SKG Radiology Hollywood Hospital, Perth, WA, Australia.

Data collection: Hollywood Private Hospital Physiotherapy Department, Perth, WA, Australia.

Statistical analysis: V.K. Bowden, PhD, School of Psychological Science, the University of Western Australia, 35 Stirling Highway, Perth, WA, Australia.

Funding

This work was supported by the Hollywood Private Hospital Research Fund, Perth, Australia (grant number: RF074).

Author information

Affiliations

Authors

Contributions

TK prepared research proposal. RJKK and DF performed surgery. ON collected and analysed RSA data. SKG Radiology and MR collected DEXA data. Hollywood Private Hospital Physiotherapy Department and SH collected patient reported outcome measure data. VKB performed statistical analysis. MR, RJKK, DF and SH prepared the manuscript.

Corresponding author

Correspondence to Michael Rutherford.

Ethics declarations

Approval for the study was obtained from the Hospital Research Ethics Committee, with its conduct in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

Prof. Khan reports personal fees from Global Orthopaedic Technology, personal fees from Zimmer Biomet, grants from AMPLITUDE, and Smith & Nephew, outside the submitted work.

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Rutherford, M., Khan, R.J.K., Fick, D.P. et al. Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting. International Orthopaedics (SICOT) 43, 2715–2723 (2019). https://doi.org/10.1007/s00264-019-04290-5

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Keywords

  • Uncemented total hip arthroplasty
  • Cementless total hip arthroplasty
  • THR
  • Autologous impaction bone grafting
  • Radiostereometric analysis
  • Dual X-ray absorptiometry