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Research Helps Doctors Choose the Best Surgical Tools for Hip Replacements

Total hip replacements are becoming more common as people live longer and are faced with severe arthritis. Doctors can't just cut the hip open and put the new joint in to replace a damaged hip joint. Some preparations are needed before a total hip implant is put in place.

The head of the femur (thigh bone) is removed. The doctor makes a hole down the femur bone for the stem of the implant to fit. Special tools are used to cut and remove bone. The most commonly used surgical tool for this task is called a toothed broach.

Another tool, the smooth tamp can also prepare the bone for the implant. The tamp can be used to move the bone to the side and pack it down instead of cutting and removing bone. Doctors are concerned that the smooth tamp method will increase a patient's risk of hip fracture.

In this study, the smooth tamp was compared to the toothed broach. Cadavers (human bodies preserved after death) were used. Researchers prepared one hip with a smooth tamp and the other hip with a toothed broach. They made sure that the bone was equal in density in all the cadavers.

This study showed that using a tamp caused more fractures. The fractures were more severe and occurred with less force than with a broach. The broach was able to slice thin layers of bone with less force. This appears to have reduced the risk of fracture.

The authors conclude that the toothed broach preserves bone when preparing for a hip joint replacement. Long-term implant survival depends on getting a good fit of the implant stem into the bone canal. Finding the best tool for the job is the focus of this research group. The tamp and broach have one tool shape and may not work for all implant types. Each tool must be studied separately.


Søren Kold, MD, et al. Femoral Fracture Risk in Hip Arthroplasty: Smooth Versus Toothed Instruments. In Clinical Orthopaedics and Related Research. March 2003. Vol. 408. Pp. 180-188.

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