Case ReportsThe Effect of a Distal Centralizer on Cemented Femoral Stems in Arthroplasty Shown on Radiographs and SPECT/CT A Case ReportBeel, Wouter MD1,a; Klaeser, Bernd MD2; Kalberer, Fabian MD1; Meier, Christoph MD1; Wahl, Peter MD1 Author Information 1Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland 2Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Switzerland aE-mail address for W. Beel: [email protected] Investigation performed at the Cantonal Hospital Winterthur, Switzerland Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (https://links.lww.com/JBJSCC/B530). JBJS Case Connector: April-June 2021 - Volume 11 - Issue 2 - e20.00973 doi: 10.2106/JBJS.CC.20.00973 Buy Metrics Abstract Case: A 70-year-old female patient underwent total hip arthroplasty (HA) using a stem cemented line-to-line without centralizer. Postoperatively, she complained of load-dependent thigh pain. Conventional radiographs identified cortical overload because of a distal cement mantle discontinuity at the level of the stem's tip, confirmed by single-photon emission computed tomography/computed tomography scan (SPECT/CT). After cement-in-cement revision using a stem with centralizer, pain ceased rapidly. The cortical overload disappeared, as confirmed on a following SPECT/CT performed for low back pain. Conclusion: In HA, the stem's tip may cause overload on the bone's cortex if the cement mantle is incomplete. Implanting a stem with centralizer avoids or cures this. Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated
