# Femoral Cancellisation Following Total Hip Arthroplasty With a Curved Triple Taper Polished Cemented Stem

## TL;DR

This study examines bone changes near hip implants, finding that cancellisation is linked to low bone density and high bone turnover, possibly due to altered stress from the implant.

## Contribution

Identifies cancellisation as an osteoporotic response linked to systemic bone density and implant-related stress changes.

## Key findings

- Cancellisation occurred in 64% of cases, primarily in specific femoral zones.
- Cancellisation was associated with lower bone mineral density and higher bone turnover markers.
- Stovepipe femoral morphology and stress shielding were more common in cancellisation cases.

## Abstract

Cancellisation is a radiolucent change occasionally observed at the bone–cement interface in cemented stems after total hip arthroplasty (THA). It is thought to reflect cortical bone remodeling due to osteoporosis or altered mechanical stress. This study aimed to investigate the characteristics, contributing factors, and mechanisms of cancellisation following THA using a curved triple-taper polished cemented stem.

We retrospectively reviewed 61 hips who underwent primary THA with the curved triple-taper polished cemented stem between October 2012 and September 2019, with a minimum follow-up of 5 years. Cancellisation was assessed radiographically, and patients were grouped by its presence. Between-group comparisons included age, sex, body weight, femoral morphology, preoperative lumbar and femoral neck bone mineral density (BMD), bone turnover markers, stress shielding, changes in periprosthetic BMD, stem subsidence, and clinical outcomes score.

Cancellisation was found in 39 hips (64%), mainly in Gruen Zones 2, 3, and 6. No significant differences in age, sex, or body weight were observed between groups. The stovepipe femoral morphology was more frequent in the cancellisation group. The cancellisation group showed significantly lower BMD and elevated bone turnover marker. Stress shielding was more advanced and the bone density ratios around the stem were significantly reduced in zones 2, 3, 6, and 7. Moreover, there were no significant differences in stem subsidence or clinical outcome scores.

Cancellisation is strongly associated with low systemic BMD and high bone turnover, suggesting a localized osteoporotic response. Its development may be influenced by altered load transmission from cemented stem fixation.