Biomechanical considerations on some postoperative problems of directly anchored total hip replacements

Uncemented total hip replacements have resulted in a higher incidence of postoperative complaints than cemented ones. The theoretical explanation of these not well defined discomforts is based on the differences of the stress and strain fields around the distal portions of the femoral components. While the noncemented stems are press-fitted and most of them tapered distally, thus creating hoop stresses and strains in the surrounding cortical bone, the shrinkage of the cement prevents these mechanical irritations. The relatively sudden disappearance of these discomforts within the first 2 postoperative years is attributed to the shift of the main zone of load transmission from the distal to the proximal portion of the stems following bone remodeling.