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Randomized Controlled Trial
. 2016 Dec;87(6):575-582.
doi: 10.1080/17453674.2016.1244958. Epub 2016 Oct 19.

Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

Mette H Hjorth  1 , Maiken Stilling  1 , Kjeld Søballe  1 , Poul Torben Nielsen  2 , Poul H Christensen  2 , Søren Kold  1
Affiliations
Randomized Controlled Trial

Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

Mette H Hjorth et al. Acta Orthop. 2016 Dec.

Abstract

Background and purpose - Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. Patients and methods - 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36-70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0-9.5) years after surgery. Results - Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03-0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0-9.5) years after surgery. Interpretation - Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.

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Figures

Figure 1.
Figure 1.
The 2 different instrument configurations used in this study: smooth tamp used for the compaction technique (left) and sharped rasp used for the broaching technique (right).
Figure 2.
Figure 2.
CONSORT flow diagram showing the inclusion/exclusion process and follow-up until 5 years.
Figure 3.
Figure 3.
Medio-lateral migration (in mm) illustrated as a pairwise comparison of broaching and compaction at 6 weeks, 12 weeks, 1 year, 2 years, and 5 years after surgery.
Figure 4.
Figure 4.
Total rotations and total translations measured at 6 weeks, 12 weeks, 1 year, 2 years, and 5 years.
See this image and copyright information in PMC

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