Cementless rectangular stems yield satisfactory results in osteoporotic bones

The present study aims to investigate the effects sof osteoporosis on prosthesis survival by comparing the femoral stem survival rates of patients with poor and relatively good bone quality.

We retrospectively investigated 61 patients with collum femoris fractures who were treated with cementless rectangular stems between 2011 and 2015 in the Orthopaedics and Traumatology Clinic of Taksim Training and Research Hospital. The preoperative pelvic anterior-posterior radiographs of the patients were evaluated. The patients were evaluated according to the Dorr classification, and no case with a type A femur was found. The patients were divided into two groups as advanced osteoporotic type C and moderate osteoporotic type B. Thirty patients were type B according to the Dorr classification and 31 were osteoporotic type C.

The femoral component survival was evaluated using the Engh and ARA criteria. The relationship of the ARA score with type B and type C groups was evaluated. The median ARA score was five (min 3-max 6) for both types. These two groups were also statistically compared concerning the ARA scores using the Mann-Whitney U test, which revealed no statistically significant difference (p=0.24 >0.05). The Engh values, another criterion for the survival of femoral components, were also compared. The median Engh values were 16.5 (min 9-max 24) for the Dorr type B group and 14 (min 9-max 24) for the type C group. According to the Mann-Whitney U test, there was no significant difference between the Engh values of the two groups (p=0.061 >0.05). Lastly, no statistically significant difference was found in the ARA or Engh loosening scores between the type C advanced osteoporotic group and the type B moderate osteoporotic group.

Our study supports the conclusion that cementless hip arthroplasty can be applied even in advanced elderly and osteoporotic patients without additional intraoperative or postoperative risks.