TP6.4 Uncemented Hip Resurfacing in Active Patients With Large Femoral Head Bone Defects: Outcomes From 235 Cases

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ID: 331378
2026
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Abstract
Abstract Introduction Large femoral head bone defects are widely considered a contraindication to hip resurfacing arthroplasty (HRA), typically directing patients toward total hip arthroplasty (THA). In hybrid HRA systems relying on cemented femoral fixation, large defects require increased cement volumes, raising concerns for thermal bone injury, incomplete defect filling, and late loosening. Uncemented femoral fixation may eliminate these risks by enabling direct bone ingrowth without cement-related complications. However, outcomes for patients with large femoral defects have not been previously reported. This study evaluates implant survivorship, failure modes, complications, and clinical outcomes following uncemented HRA in patients with femoral head defects ≥3 cm3. Methods A prospectively maintained single-surgeon database was retrospectively searched for all uncemented metal-on-metal HRAs performed between 2007 and 2023 in patients with femoral head bone defects ≥3 cm3. Defects were debrided intraoperatively and packed with autologous acetabular reamings prior to press-fit implantation; a bone morphogenetic protein preparation was added in 12.1% of cases. Failures, reoperations, and complications were compared to published HRA benchmarks in patients without femoral defects. Results Two hundred thirty-five consecutive cases met inclusion criteria. Overall failure rate was 1.3%: one loose acetabular component (0.4%), one femoral fracture (0.4%), and one dislocation (0.4%) - comparable to standard HRA benchmarks. One reoperation unrelated to femoral implant performance occurred (0.4%). Complications included two dislocations (0.9%), one fracture (0.4%), and one urinary-retention (0.4%). No femoral loosening attributable to defect filling was identified. Conclusion Uncemented HRA in patients with large femoral head defects yielded survivorship equivalent to patients with intact bone. Autologous graft impaction with press-fit fixation reliably achieved osseointegration in compromised bone without cement-related complications. These findings directly expand arthroplasty options for the patients with significant bone loss.
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Authors Dani Gaillard-campbell, Thomas Gross
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.167
URL
https://doi.org/10.1093/jhps/hnag043.167
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