Mid-term outcomes of compaction autologous bone grafting in uncemented primary total hip replacement stems

Fixation and long-term stability of collared, uncemented stems, such as the CORAIL^® collared stem, in total hip arthroplasty (THA), depend on a strong cancellous bone sleeve and subsequent osseointegration. This study aimed to investigate bone reaction and mid-term outcomes following compaction autologous bone grafting in uncemented stems in primary THA.

This study retrospectively reviewed patients with primary THA using CORAIL^® collared stem and having ≥ 5 years follow-up. Patients were divided into the bone graft and control groups based on the use of compaction autologous bone grafting. Demographic characteristics, fracture risk, operation time, complications, revisions, and radiologic measures, such as stress shielding and reactive lines were compared between the groups.

A total of 140 cases (85% women, mean age: 63 years, mean follow-up: 72 months) were included. Autologous bone graft was used in 32 (23%) cases. No significant differences in terms of age, sex, diagnoses, follow-up duration, or operation time were observed between the groups. Stress shielding frequency remained stable at 9.4% between 1y and 5y in the bone graft group, but increased from 13.9 to 28.7% in the control group, resulting in the latter having a higher 5-y frequency than the bone graft group (p = 0.0004). Reactive lines increased from 1y to 5y in both groups (bone graft: 6.3-37.5%, p = 0.0015; control: 4.6-26.9%, p < 0.001) with no significant differences between groups. There were no instances of stem subsidence/loosening or stem revision in either group.

Autologous compaction bone grafting achieved satisfactory fixation of the uncemented CORAIL^® collared stem without requiring distal fixation and mitigated stress shielding. Larger, prospective studies with longer follow-ups are needed to confirm the clinical implications of these mid-term results in primary THA.