Diagnosis of and Early Revision Surgery for Biological Fixation Failure Due to Proximal-Distal Mismatch of Proximally Coated Tapered Cementless Stem

• Main Authors: Yasuhiro Homma, MD, PhD, So Kawakita, MD, Tomonori Baba, MD, PhD, Taiji Watari, MD, PhD, Kazuo Kaneko, MD, PhD
• Format: Article
• Language: English
• Published: Elsevier 2020-12-01
• Series: Arthroplasty Today
• Subjects: Cementless stem; Proximal-distal mismatch; Revision THA; Digital tomosynthesis; Scintigraphy
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352344120301795
• ISSN: 2352-3441

The diagnosis of and decision-making for early revision surgery to treat failure of biological fixation with a proximally coated cementless stem are challenging. A 73-year-old woman was referred to our hospital with thigh pain 2 years after the initial total hip arthroplasty. Although a plain radiograph showed no signs indicating biological fixation failure, digital tomosynthesis showed a highly radiodense line along the proximal part, and bone scintigraphy showed uptake at the distal part. With the diagnosis of biological fixation failure due to the proximal-distal mismatch, the cementless stem was revised to a cemented stem, and the thigh pain was improved after the revision surgery. Digital tomosynthesis and bone scintigraphy can be helpful for the diagnosis of biological fixation failure due to proximal-distal mismatch.