Proximal bone remodelling differed between two types of titanium long femoral components after cementless revision arthroplasty

In revision surgery with proximal femoral bone loss, progressive bone atrophy due to stress shielding remains a concern. We compared 2-year radiological results between two types of cementless long titanium stems with different configurations and surface coatings. Of 17 hips implanted with a wholly hydroxyapatite-coated stem, 12 (71%) exhibited stress shielding of the second degree or higher according to Engh’s criteria, and the mean relative bone mass index decreased from 22.1% pre-operatively to 14.6% at 2 years post-operatively. In 23 hips implanted with a sand-blasted, conically shaped stem, no hip showed stress shielding of the second degree or higher. The mean relative bone mass index increased from 21.6% to 31.4%. These results indicate that the configuration and surface coating of the stem have a significant influence on proximal bone remodelling after revision surgery.