Crowe Ⅲ型髋关节发育不良人工全髋关节置换髋臼解剖重建与非解剖重建髋关节生物力学有限元分析

目的：应用有限元分析研究CroweⅢ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH) 全髋关节置换(total hip arthroplasty,THA)髋臼解剖重建与非解剖重建髋关节的生物力学为临床THA髋臼解剖重建提供理论基础和实验依据。方法：选取1例因左侧Crowe Ⅲ型DDH伴终末期髋骨关节炎于2020年4月就诊并行左侧全髋关节置换的患者,女,57岁。术前、术后分别行骨盆CT平扫三维重建。在Mimics和3-Matic软件里建立14组髋臼杯不同前倾角、外展角、旋转中心高度模型并进行材料赋值,在Abaqus软件里设置边界和负载条件,计算并观察髋关节应力峰值和分布。结果：对于Crowe Ⅲ型DDH全髋关节置换术,当旋转中心解剖重建,髋臼杯外展角设置为40°时,髋臼杯前倾角5°~25°变化时,髋臼杯、聚乙烯内衬最低Von Mises值出现在前倾角20°;当旋转中心解剖重建,髋臼杯前倾角设置为15°时,髋臼杯外展角30°~55°变化时,髋臼杯、聚乙烯内衬最低Von Mises值出现在外展角35°;当髋臼杯前倾角设置为15°、外展角设置为40°时,旋转中心上移0~20 mm变化时,髋臼杯、聚乙烯内衬最低Von Mises值出现在旋转中心上移10 mm。在所有14组髋臼杯参数模型中,旋转中心解剖重建,髋臼杯前倾角15°、外展角35°时,髋臼、髋臼杯、聚乙烯内衬Von Mises值最低。结论：在Crowe Ⅲ型DDH全髋关节置换术中,建议解剖重建旋转中心,髋臼杯前倾角15°、外展角35°,同时进行髋臼外上方植骨并增加螺钉以进一步减少髋关节应力峰值。     

个性化髋臼导板在单侧全髋关节成形术中应用的实验研究

目的探讨个性化髋臼导板在单侧全髋关节成形术(THA)中的应用。方法2018年11月至2020年4月中国人民解放军联勤保障部队第920医院骨科选取人尸体髋标本20例(由昆明医科大学人体解剖学教研室提供)进行实验研究。每例标本右侧定义为导板侧,左侧定义为对照侧。经CT扫描后对每例标本髋关节行三维重建,计算并确定导板侧髋关节旋转中心(HJC)及旋转轴线,设计并制作与导板侧髋臼Harris窝表面形态一致的反向导板,辅助THA术中髋臼假体植入。测量术后导板侧髋臼假体与对照侧髋臼的外展角(β)、前倾角(α)、HJC与泪滴的垂直距离(H)和水平距离(W)并进行比较。采用Prism 6.0软件对数据进行统计学分析。结果个性化髋臼导板与髋臼Harris窝贴合紧密且稳定性好。髋臼导板辅助臼杯假体植入后与对照侧髋臼方位对称。导板侧与对照侧β角分别为(49.9±4.1)°和(49.5±4.7)°,α角分别为(17.7±3.1)°和(18.3±3.5)°,H值分别为(21.6±2.8)mm和(21.9±3.4)mm,W值分别为(29.7±3.1)mm和(30.90±3.31)mm,差异均无统计学意义(均P>0.05)。结论应用个性化髋臼导板可做为辅助单侧THA术中髋臼假体准确植入的有效手段。     

人工智能辅助手术规划系统在个体化全髋关节假体精准植入中的应用

目的 与传统二维胶片模板测量术前计划比较,探讨人工应用智能辅助三维数字化手术规划系统在个体化全髋关节置换术（total hip arthroplasty,THA）假体植入中应用的准确性。方法 回顾性分析88例行单侧THA手术病人的临床资料,其中传统模板组（44例）,人工智能组（44例）,记录比较两组在假体型号大小选择、植入位置、患侧偏心距、双下肢等长重建等方面的差异。结果 人工智能组髋臼杯和股骨柄假体型号的预测吻合率分别为95.5%、88.6%,均高于传统模板组的75.0%、65.9%,差异有统计学意义（P＜0.05）。人工智能组手术后偏心距和肢体长度的差值分别为（4.73±2.97） mm、（3.42±2.32） mm,均较传统模板组更小,差异有统计学意义（P＜0.05）。结论 人工智能辅助手术规划系统对人工髋关节假体型号的预测、患侧肢体偏心距的恢复、双下肢等长重建更加精准。     

前路辅助上方关节囊入路全髋关节置换对髋臼假体位置及术后早期髋关节功能的影响

目的 探讨前路经皮辅助上方关节囊入路（Anterior SuperPATH）行人工全髋关节置换术（THA）对髋臼假体位置及早期髋关节功能的影响。方法 回顾性分析2019年11月至2022年6月在我院行THA的75例病人的临床资料,根据手术入路不同分为两组,38例采用前路经皮辅助上方关节囊入路的病人纳入前路通道组,37例采用传统后外侧入路的病人纳入后外侧组。记录并比较两组手术时间、术中出血量、术后卧床时间、住院时间、术后24 h疼痛视觉模拟量表（VAS）评分,以及术后1周、1个月的髋关节Harris评分。术后拍摄骨盆正位X线片,测量髋臼假体的外展角与前倾角,并与Lewinnek安全区（髋臼外展角40°±10°、髋臼前倾角15°±10°）进行比较,评估放置髋臼假体的准确性。结果 病人随访8~21个月,平均为12.1个月。所有病人术后6个月均未见脱位。前路通道组手术时间长于后外侧组,手术出血量少于后外侧组,术后卧床时间与住院时间短于后外侧组,术后24 h的VAS评分低于后外侧组,术后1周、1个月的髋关节Harris评分高于后外侧组,两组比较,差异均有统计学意义（P＜0.05）。前路通道组的外展角和前倾角分别为42.78°±4.98°、15.29°±4.97°,二者均在安全区域的比例为84.2%（32/38）;后外侧组的外展角和前倾角分别为41.49°±5.50°、13.58°±4.74°,二者均在安全区域的比例为83.8%（31/37）;两组间比较,差异均无统计学意义（P＞0.05）。结论 采用前路经皮辅助上方关节囊入路和后外侧入路行THA,髋臼假体位置无明显差异。虽然前路经皮辅助上方关节囊入路手术时间更长,但能明显减少手术出血,缓解手术疼痛,缩短住院时间,加速康复。     

综合保髋手术治疗髋关节发育不良晚期病变远期疗效评价

目的:探讨Chiari截骨、血管束植入为基础的综合手术治疗髋关节发育不良晚期病变的远期疗效。方法:42例（61髋）髋关节发育不良晚期病变患者接受以Chiari截骨、血管束植入为基础术式的综合手术治疗。本组年龄27⁴2岁,平均36.1岁。61髋中行单纯Chiari骨盆截骨、股骨头内血管束植入术39髋,配合髋臼加盖术16髋,配合股骨近端旋转截骨术2髋,配合髋臼加盖术及股骨近端旋转截骨术4髋。结果:本组平均随访时间8.4年,最后随访时,5例5髋已行人工髋关节置换,其他37例56髋Harris评分术前平均58分,术后平均83分,疗效优良43髋（76.8%）。CE角:术前平均8.7°,术后平均28.5°。股骨头覆盖指数:术前平均61.4%,术后平均83.2%。结论:该综合手术方法对髋关节发育不良晚期病变可以显著缓解临床症状,改善髋关节功能,提高患者生活质量,大大延缓人工全髋关节置换术的时间。     

机器人辅助人工全髋关节置换的短期疗效分析

目的　探讨机器人辅助人工全髋关节置换术（total hip arthroplasty, THA）的短期疗效。方法　回顾性分析2018年8月至2019年3月于我科采用MAKO机器人系统辅助植入臼杯行THA手术治疗的79例（100髋）病人的临床资料,纳入机器人辅助组,并选择同一手术医师施行的80例（100髋）徒手THA病人纳入对照组,均采用标准髋关节后外侧入路。收集比较两组病人的围手术期相关信息,如手术时间、住院时间、髋臼杯位置、术后下肢长度差异（limb length discrepancy, LLD）、围手术期并发症及髋关节Harris评分（hip Harris score, HHS）。结果　病人术后均得到3个月以上随访,两组均未发生髋关节脱位、无菌性松动、假体周围感染或翻修。机器人辅助组的手术时间为（95.92±15.64） min,明显长于对照组的（83.12±18.22） min,两组比较,差异有统计学意义（t=3.309,P=0.001）。两组的术后HHS均较术前显著改善,但组间比较,差异无统计学意义（P＞0.05）。机器人辅助组的前倾角、外展角、LLD和偏心距差异分别为19.05°±5.03°、41.14°±3.66°、（2.87±3.75） mm、（3.34±1.79） mm,对照组分别为16.91°±5.48°、40.35°±6.57°、（4.23±3.12） mm、（3.98±2.04） mm;两组的前倾角和LLD比较,差异均有统计学意义（P均＜0.05）,但两组间的外展角和偏心距差异比较,差异无统计学意义（P＞0.05）。机器人辅助组的手术假体位于Lewinnek安全区内的比例更高（91% vs. 82%）,但两组间比较,差异无统计学意义（χ²=3.468,P=0.063）。结论　机器人辅助THA能够优化髋臼杯假体植入的精确性,不增加手术的并发症,但其远期效果仍需进一步研究证实。     

3D打印技术辅助髋臼成形术治疗脑瘫儿童髋关节脱位

目的:探讨通过3D打印技术明确髋臼发育不良类型选择最合适的髋臼成形术治疗脑瘫儿童髋关节脱位的适应证和临床疗效。方法:自2019年7月至2019年12月,采用3D打印技术辅助髋臼成形术治疗7例脑瘫儿童髋关节脱位,其中男3例,女4例;年龄3~8岁;左侧3例,右侧2例,双侧2例;2例髋关节半脱位,5例髋关节脱位。患儿术前均行骨盆-双股骨全长CT扫描。通过3D打印重建技术,判断髋臼发育不良类型:前侧2髋,前外2髋,外上1髋,后侧2髋,后外1髋,无发育不良1髋(未做髋臼成形术)。对8髋分别进行Pemberton,Dega和San Diego手术模拟,寻找最合适的手术方式并手术。比较术前和末次随访外移比例(migration percentage,MP),髋臼指数(acetabular index,AI),中心边缘角(center-edge angle,CEA),Shenton线和粗大运动功能分级(gross motor function classification system,GMFCS)的变化,并记录其并发症情况。结果:术后患者伤口愈合良好,无并发症发生。7例患者获随访,时间18~24个月。8髋Ⅰ期行软组织松解+股骨近端内翻去旋转短缩截骨+髋关节复位+髋臼成形术;1髋Ⅰ期行软组织松解+股骨近端内翻去旋转短缩截骨+髋关节复位术。MP由术前的58%~100%降至末次随访时的0~17.9%。AI由术前的25.0°~47.6°降至末次随访时的11.1°~25.3°。CEA由术前的0°改善至末次随访时的21.1°~48.5°。Shenton''线均由中断变为连续。其中5例GMFCS分级下降1级,2例无变化。结论:脑瘫儿童髋关节脱位中髋臼发育不良的类型多样,髋臼成形术适用范围也有差异,借助3D打印技术计算机模拟手术可选择最合适的手术方式并判断治疗效果,对脑瘫儿童髋关节脱位做到个体化、精准化治疗。     

髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良的对比研究

目的 比较全髋关节置换术（total hip arthroplasty, THA）中行髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良（developmental dysplasia of the hip, DDH）的临床疗效。方法 对2012年8月至2015年12月于我科行THA治疗Crowe Ⅱ、Ⅲ型DDH合并髋关节骨性关节炎（Tonnis Ⅲ期）的37例病例进行回顾性分析,根据髋臼重建方式分组：其中髋臼原位重建组17例,高髋关节中心重建组20例。比较两组病人的手术时间、手术出血量、Harris评分、影像学假体松动率。结果 37例病人平均随访41个月（25~63个月）。髋臼原位重建组的手术时间和手术出血量分别为（119±16） min、（413±36） ml,高髋关节中心重建组的手术时间和手术出血量分别为（92±21） min、（389±44） ml,两组间比较,差异均有统计学意义（t=29.561,P=0.021;t=0.682,P=0.231）。两组术后的Harris评分均较术前显著提高,但两组间术前及末次随访的Harris评分比较,差异均无统计学意义（P均＞0.05）。髋臼原位重建组中有2例少量植骨吸收,两组随访未见影像学假体松动。结论 高髋关节中心技术的手术时间较髋臼原位重建更短,两种技术治疗Crowe Ⅱ、Ⅲ型DDH的中期临床疗效较好,均可显著恢复病人的髋关节功能。     

3-D打印技术辅助人工全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良合并股骨近段畸形一例

目的介绍3-D打印技术辅助人工全髋关节置换术(total hip arthroplasty,THA)治疗1例Crowe Ⅳ型髋关节发育不良合并股骨近段畸形的临床经验。方法 2017年2月,收治1例40岁Crowe Ⅳ型髋关节发育不良合并股骨近段畸形的女性患者。术前采用Mimics软件建立患侧髋关节三维数字模型,3-D打印患侧股骨模型,根据模型设计股骨假体截骨位置及截骨大小。采用Magics 19.0软件设计制作个性化股骨截骨导板三维模型,并3-D打印。THA术中应用截骨导板进行股骨截骨矫形。结果手术时间98 min。术后第2天髋关节正侧位X线片检查示,髋臼假体安放、螺钉植入角度及位置均理想,恢复髋臼正常旋转中心,股骨截骨两端对位良好,下肢力线恢复正常。患者获随访6个月,Harris评分为95分,较术前(38分)明显提高;疼痛视觉模拟评分(VAS)为0分,较术前(7分)明显下降。随访期间未发生假体松动、感染、血栓形成等并发症。结论 3-D打印技术辅助THA治疗Crowe Ⅳ型髋关节发育不良合并股骨近段畸形,能简化手术操作、提高手术准确度、减少组织损伤、降低手术风险,取得满意临床疗效。     

Crowe IV 型髋关节发育不良全髋关节置换术前计算机辅助设计

 目的 探索采用计算机辅助技术, 对接受全髋关节置换(total hip arthroplasty, THA)的 Crowe IV型髋关节发育不良患者进行术前评估, 确定髋臼大小、骨缺损程度, 并在此基础上辅助手术设 计、假体选择及骨缺损修复。 方法2011 年3 月至10 月, 共10 例(13 髋)Crowe IV型高位脱位髋关节发 育不良患者接受THA 治疗。患者均为女性;年龄32~74 岁, 平均42 岁。所有患者术前行髋关节三维CT 扫描, 然后将扫描数据输入SuperImage 软件重建骨盆及髋臼。重建后在不同角度精确评估真臼位置, 测 量真臼大小及前后柱厚度, 评估骨缺损程度;将髋臼试模、骨缺损修复材料(钽金属垫块)按1颐1 大小扫 描输入计算机系统, 进行术前模拟安放, 确定髋臼假体大小、安放位置;髋臼假体安放后评估遗留的骨缺 损, 确定骨缺损修复材料, 进行骨缺损修复模拟测试。 结果 9 例(12 髋)术中实际安放髋臼假体型号与 术前计算机辅助设计一致, 1 例(1髋)假体型号较术前设计大一号。所有患者髋臼安放位置与术前计划 一致, 均安放于真臼。髋臼骨缺损修复按术前设计:4 髋因髋臼顶部骨缺损明显(臼顶部骨性覆盖 < 70%), 采用钽金属垫块修复骨缺损, 以增强髋臼的稳定性;7 髋采用Harris 法自体股骨头植骨修复骨缺 损;2 髋髋臼杯植入后臼顶覆盖可, 术中未植骨。 结论 对Crowe IV型髋关节发育不良者行计算机辅助 下THA术前设计, 有助于术前精确评估真臼发育情况、大小及髋臼骨缺损, 提高手术治疗精确性。     

Is Robotic-Assisted Technology Still Accurate in Total Hip Arthroplasty for Fibrous-Fused Hips?

BackgroundTotal hip arthroplasty (THA) for fibrous-fused hips is technically demanding. This study aimed to evaluate the precision and accuracy, as well as the rate of conversion of robotic-assisted THA in such difficult patients.MethodsWe retrospectively analyzed 67 patients (84 hips) who underwent THA with fibrous-fused hips between August 2018 and June 2021 at our institution. Demographics, acetabular cup positioning, leg-length discrepancies, and postoperative Harris hip scores were recorded for all patients. Thirty-six patients (44 hips) who underwent robotic-assisted THA and 31 patients (40 hips) who underwent manual THA were enrolled in this study.ResultsThe robot accurately executed the preoperative plan, and there were no statistically significant differences between the preoperative planned anteversion, inclination, and postoperative measurements. In the robotic group, the percentage of acetabular cups in the safe zone was significantly higher than in the manual group (87.2 versus 55%, respectively, P = .042). The rate of conversion to manual THA for various reasons in the robotic-assisted THA group was 11.4% (5/44). Compared with manual THA, the mean increase in operative time for conversion from robotic-assisted to manual THA was 24 min (P < .001).ConclusionIn patients who have fibrous-fused hips, preoperative planning can be accurately executed by robotic-assisted technology. Compared with manual THA, robotic-assisted THA had a remarkable advantage in improving the frequency of achieving cup positioning within the target zone. Overall, robotic-assisted technology was helpful in such difficult cases, and the approximately 11.4% of cases converted to manual THA are reminders that surgeons should be thoroughly prepared preoperatively.     

Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip

Purpose  

In reconstruction of congenital hip dislocation by total hip arthroplasty (THA), positioning of the acetabular component in the true acetabulum is sometimes accompanied by shortening of the femur. Shortening of the femur is of importance for minimising risk of damaging neurovascular structures due to excessive limb lengthening. Furthermore, reduction of the femoral head into the true acetabulum remains challenging without shortening of the femur.     

Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

In total hip arthroplasty (THA), accurate positioning of components is important for the functionality and long life of the implant. Femoral component version has been underinvestigated when compared with the acetabular cup. Accurate prediction of the femoral version on the preoperative plan is particularly important because a well-fitting uncemented stem will, by definition, press-fit into a version that is dictated by the anatomy of the proximal femur. A better understanding of this has recently become an unmet need because of the increased use of uncemented stems and of preoperative image-based planning. We present the first, three-dimensional (3D) comparison between the planned and achieved orientation and position of the femoral components in THA. We propose a comparison method that uses the 3D models of a, computed tomography-generated (CT-generated), preoperative plan and a postoperative CT to obtain the discrepancy in the six possible degrees of freedom. We ran a prospective study (level 2 evidence) of 30 patients undergoing uncemented THA to quantify the discrepancy between planned and achieved femoral stem orientation and position. The discrepancy was low for femoral stem vertical position and leg length, and varus-valgus and anterior-posterior orientation. The discrepancy was higher for femoral version with a mean (±SD) of −1.5 ± 7.8 deg. Surgeons should be aware of the variability of the eventual position of uncemented stems in THA and acknowledge the risk of achieving a less-than-optimal femoral version, different from the preoperative 3D CT plan.     

Comparison of Acetabular Shell Position Using Patient Specific Instruments vs. Standard Surgical Instruments: A Randomized Clinical Trial

Total hip arthroplasty (THA) survivorship relies largely upon appropriate acetabular cup placement. The purpose of this prospective randomized controlled trial was to determine whether the use of a preoperative 3D planning software in combination with patient specific instrumentation (PSI) results in improved cup placement compared with traditional techniques. Thirty-six THA patients were randomized into standard (STD) or PSI technique. Standard approach was completed using traditional techniques, while PSI cases were planned and customized surgical instruments were manufactured. Postoperative CT scans were used to compare planned to actual results. Differences found between planned and actual anteversion were − 0.2° ± 6.9° (PSI) and − 6.9° ± 8.9° (STD) (P = 0.018). Use of 3D preoperative planning along with PSIs resulted in significantly greater anteversion accuracy than traditional planning and instrumentation.     

A Comparison of Acetate vs Digital Templating for Preoperative Planning of Total Hip Arthroplasty : Is Digital Templating Accurate and Safe?

The purposes of this study were to compare the accuracy of acetate and digital templating for primary total hip arthroplasty (THA) and to determine if digital templating is safe. Preoperative planning was performed on 50 consecutive preoperative radiographs during 2005. Templating results were compared with the actual hip implants used. Interrater reliability of acetate templating and accuracy of acetate and digital templating were recorded. Digital measurement overestimated acetabular size (P < .001) and underestimated the femoral size (P = .03). The absolute errors were larger for digital compared with acetate templating; however, mean absolute errors did not differ significantly (acetabulum, P = .090; femur, P = .114). Acetate and digital templating can accurately predict the size of THA implants. Digital templating was determined to be acceptably safe for preoperative planning of primary THA operations.     

Cost-Effectiveness of Preoperative Spinal Imaging Before Total Hip Arthroplasty

BackgroundThe risk of instability, dislocation, and revision following total hip arthroplasty (THA) is increased in patients with abnormal spinopelvic mobility. Seated and standing lateral lumbar spine imaging can identify patients with stiff/hypermobile spine (SHS) to guide interventions such as changes in acetabular cup placement or use of a dual-mobility hip construct aimed at reducing dislocation risk.MethodsA Markov decision model was created to compare routine preoperative spinal imaging (PSI) to no screening in patients with and without SHS. Screened patients with SHS were assumed to receive dual-mobility hardware while those without SHS and nonscreened patients were assumed to receive conventional THA. Cost-effectiveness was determined by estimating the incremental cost-effectiveness ratio. Effectiveness measured as quality-adjusted life years (QALYs), with $100,000 per additional QALY as the threshold for cost-effectiveness. Sensitivity analyses were performed to determine the robustness of the base-case result.ResultsThe screening strategy with PSI had a lifetime cost of $12,515 and QALY gains of 16.91 compared with no-screening ($13,331 and 16.77). The PSI strategy reached cost-effectiveness at 5 years and was dominant (ie, less costly and more effective) at 11 years following THA. In sensitivity analyses, PSI remained the dominant strategy if prevalence of SHS was >1.9%, the cost of PSI was <$925, and the cost of dual-mobility hardware exceeded the cost of conventional hardware by <$2850.ConclusionScreening patients for SHS prior to THA with PSI is both less costly and more effective and should be considered as part of standard presurgical workup.     

Assessment of complex hip deformity using three-dimensional CT image

We used three-dimensional computed tomography (CT) to define the bony configuration of the acetabulum and the proximal femur and their relationship to complicated and/or neglected congenital hip dislocations and Legg-Calvé-Perthes disease. Three-dimensional CT was useful for preoperative planning and postoperative evaluation of hips with complex deformities, which were often difficult to assess by means of plain radiographs or conventional two-dimensional CT. The coverage of the femoral head under the acetabular roof and the severity of the hip dysplasia could be assessed easily with three dimensional CT, and acetabular and femoral torsion could be measured.     

Direct Cementation of Dual Mobility Cups Into the Bony Acetabulum in Primary Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Minimum 5-Year Follow-Up

BackgroundCemented dual mobility cups (DMCs) are commonly used in combination with acetabular reinforcement devices. Indeed, according to literature, direct cementation of metal-backed acetabular components into the bony acetabulum remains controversial as this technique is potentially associated with increased rates of aseptic loosening. Therefore, this study aimed to evaluate the clinical and radiographic outcomes of DMC cemented into the bony acetabulum in primary total hip arthroplasty (THA).MethodsA total of 49 THA (48 patients, mean age 78 years [range, 51 to 91]) performed with direct cementation of a DMC into the bony acetabulum were prospectively included in our total joint registry and retrospectively reviewed. The clinical outcome was assessed using the Harris hip score (HHS). The radiographic outcome included measurement of component positioning and occurrence and progression of demarcation around the cemented DMC. Complications were reported with a particular attention to cemented fixation failure and aseptic loosening.ResultsAt a 7-year mean follow-up (range, 5 to 8), the pre-to postoperative HHS improved from 47 (range, 30 to 58) to 92 points (range, 80 to 98) (P < .01). Nonprogressive and focalized demarcations were observed in 7 THA (14%). Importantly, no progressive demarcation or DMC aseptic loosening was observed.ConclusionDirect cementation of DMC into the bony acetabulum ensured a stable fixation with no progressive demarcation or aseptic loosening at midterm follow-up. Therefore, this technique can be selectively considered in primary THA, especially in elderly or frail patients to avoid potential mechanical failure of press-fit fixation due to altered bone quality or additional morbidity related to the use of acetabular reinforcement devices.