PURPOSE Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique. METHODS From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction. RESULTS There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39). CONCLUSIONS Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes. AUSTRALIAN CLINICAL TRIAL REGISTRATION NUMBER ACTRN12618000652279.

中文翻译：

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随机临床试验评估未骨水泥全髋关节置换干的迁移，有无自体植骨。

目的老年人由于股骨直肠管扩张和皮质变薄而导致原发性全髋关节置换术（THR）中未胶合的茎干，导致该人群骨折和下陷的发生率较高。为了消除这种担忧，作者开发了一种使用自体冲击式植骨的技术，以实现更好的股骨干适配。这项随机临床试验的目的是评估该技术的有效性。方法从2013年至2015年，共纳入98名连续参与者（100例主要THR程序），纳入单机构，单盲，随机临床试验，并通过放射立体分析（RSA）评估自体自体植骨植骨的有效性。与传统的非硬性原发性THR技术相比，非硬性原发性THR技术更是如此。主要结果指标是使用RSA进行股骨成分迁移。次要结果是手术后股骨近端骨密度（使用DEXA），髋功能和生活质量（使用牛津髋关节评分（OHS）和12型简短健康调查（SF-12）），髋关节疼痛和患者满意度。结果移植组和无移植组在股骨成分稳定性（p> 0.5）或骨膜吸收方面没有差异，两年。移植组和不移植组的OHS，SF-12，疼痛或满意度在两年时也没有差异（p> 0.39）。结论在非骨水泥型原发性THR中自体自体植骨已显示出其短期术后效果与标准非骨水泥化技术相当，同时为股骨干大小之间的患者提供了更好的适应性。