Bone remodelling after total hip arthroplasty

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Bone remodelling of the proximal femur following total hip arthroplasty (THA) is related to stress deviation with respect to physiological condition. The clinical relevance of this process is much debated with respect to its role in THA failure. In the present study a group of 475 An.C.A. anatomic cementless stems implanted in our institution were assumed as clinical reference. Of them, 294 had a short stem and 181 had a long stem. Stress shielding was X-ray evaluated in each patient. The survivorship analysis of this study group (negative events = stress shielding) showed significantly (p<0.05) lower survival rates at 25 months follow-up for patients with long-stem implants. A 3-D FEM model of the proximal femur was used to analyse the load transfer mechanism for the two types of stems in fully or proximally only bonding conditions. Little difference was predicted in the proximal stress magnitudes for the different stem lengths. On the contrary, stem-bone bonding leads to a notable increase in the stress shielding.