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Use of an extended offset femoral neck component
1%
23/1833
Use of a proximal circumferentially coated ingrowth stem
64%
1165/1833
Use of a collared stem
3%
61/1833
Use of a long femoral stem
2%
32/1833
Ensuring that the stem fills the diaphysis of the femur
29%
540/1833
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Osteolysis of the femur is caused by activation of macrophages by microscopic polyethylene particles within the "effective joint space", defined as any area where joint fluid can come into contact with bone. This can occur above the acetabular cup, through screw holes, and down the femoral shaft around the prosthetic stem. Ideally, with a cementless stem, both the proximal and metaphyseal femur are well filled by the prosthesis. Collared stems are used to augment poor calcar bone quality or bone loss. Sinha et al showed in a retrospective review of 101 hips with cementless circumferentially coated femoral stems no distal femur osteolysis occurred, but 82% showed “evidence of proximal femur stress shielding”, though only 38% showed proximal femoral osteolysis.
2.3
(55)
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