Management of Severe Osteoporosis in Primary Total Hip Arthroplasty

Severe osteoporosis is becoming a common problem faced by surgeons performing primary hip arthroplasty. As the population ages, osteoporosis is increasing, especially as the population aged more than 80 years increases. Patients may need a total hip replacement to treat osteoarthritis or an acute femoral neck fracture. Recent data have shown an advantage to hip replacement in this population. Although uncemented and cemented designs of femoral prostheses have been used successfully, there is a high rate of periprosthetic fracture associated with the use of uncemented stems in patients with osteoporosis. Successful replacement requires knowledge of the particular stem type used in the weakened proximal femur. Total hip replacement for fracture also has a higher rate of dislocation. Additional study is required to determine if a particular uncemented stem design is better than others in this scenario or whether more use of cemented stems would help to limit periprosthetic fracture.