Impaction Autograft Enhancement of Femoral Stem Fixation in Primary Cementless THA.

The goals of femoral stem fixation in total hip arthroplasty (THA) are: 1) to achieve long-term fixation of bone-toimplant materials; 2) to maintain the anatomy and biologic integrity of the proximal femur; and 3) to resist access of wear particles to the femoral canal. Cementless fixation has proven to be successful; however, reported failures secondary to osteolysis, stress shielding, and aseptic loosening have hampered enthusiasm for this approach. Unsolved issues in cementless femoral stem fixation include prosthetic material, size and dimension, extent and type of coating, collar or no collar, and fit and fill. Cortical contact designs require customization or large anatomic-type proximal contouring. Removal of normal cancellous and cortical bone is frequently required to achieve cortical contact