Primary and revision THA using a stemless metaphyseal-loading implant above distorted proximal femoral anatomy.

Total hip arthroplasty is well established as a successful treatment for end stage arthritis, with a wide variety of components currently available. Using traditional stemmed implants in patients with a distorted proximal femur can be technically challenging with an increased risk of complications. We present seven patients with distorted proximal femoral anatomy or failed hip arthroplasty in whom a short, metaphyseal loading implant was utilised. At minimum two-year follow-up there have been no complications with all stems stable and well fixed radiologically. Average improvement in Oxford Hip Score is 32. We suggest that a short, metaphyseal loading prosthesis can be considered in cases where a conventional stemmed implant may not be suitable due to challenging proximal femoral anatomy.

Conversion of a long distally fixed uncemented revision femoral stem to a proximally fixed implant following fatigue fracture.

There has been increasing focus on bone conservation through proximal fixation in primary hip arthroplasty. However, the debate regarding fixation in revision arthroplasty and which factors influence implant choice remains less clear-cut. We report a case involving fatigue fracture of a long, distally well-fixed, uncemented revision stem. This was revised to a proximally fixed implant. This case highlights a number of issues when considering the choice of implant in hip revision surgery and raises the issue of bone conservation in revision surgery. We would suggest that in both primary and revision hip arthroplasty meticulous pre-operative consideration of the choice of implant should be undertaken, especially in the younger patient with higher expectations and functional demands.