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Updated: Nov 2, 2025
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
The Effect of a Distal Centralizer on Cemented Femoral Stems in Arthroplasty Shown on Radiographs and SPECT/CT: A
Wouter Beel1, Bernd Klaeser2, Fabian Kalberer1
1Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
Case:
A 70-year-old female patient underwent total hip arthroplasty (HA) using a stem cemented line-to-line without centralizer. Postoperatively, she complained of load-dependent thigh pain. Conventional radiographs identified cortical overload because of a distal cement mantle discontinuity at the level of the stem's tip, confirmed by single-photon emission computed tomography/computed tomography scan (SPECT/CT). After cement-in-cement revision using a stem with centralizer, pain ceased rapidly. The cortical overload disappeared, as confirmed on a following SPECT/CT performed for low back pain.
Conclusion:
In HA, the stem's tip may cause overload on the bone's cortex if the cement mantle is incomplete. Implanting a stem with centralizer avoids or cures this.
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