Effect of cavity preparation and bone mineral density on bone‐interface densification and bone‐implant contact during press‐fit implantation of hip stems

ABSTRACT Implant loosening and periprosthetic fracture are two major revision causes for uncemented hip stems. The chosen method of cavity preparation could play a key role for both failure mechanisms. The aim of this study was to determine the dependence of the broach type as well as patient bone mineral density (BMD) on densification and contact conditions at the bone‐implant interface. Hip stems were implanted into cadaveric femora using compaction, blunt extraction or sharp extraction broaches with computed tomography scans performed prior to broaching, after broaching and after stem implantation. Proximal periprosthetic bone densification as well as press‐fit, contact area and stem seating relative to the last broach were determined. Median bone densification was higher with the compaction and blunt extraction broaches compared to sharp extraction broaches (181% and 177%, respectively, p = 0.002). The bone densification of femora prepared with compaction broaching increased with higher BMD (R2 = 0.183, p = 0.037), while stem seating decreased with higher BMD for all broach types (R2 = 0.259, p = 0.001). Incomplete seated prostheses were associated with smaller press‐fit and bone‐implant contact area (R2 = 0.249, p = 0.001; R2 = 0.287, p