We have shown that people who are obese (BMI>29) or who have low bone density have a higher risk of early femoral failure (fractures and head collapse). Therefore all patients have a DEXA scan and a Vitamin D level checked preoperatively.
Uncemented components are used exclusively, Vitamin D is supplemented as needed, biological sourced (algae) calcium is recommended and special postoperative protocols are instituted based on DEXA bone density numbers and BMI.
Using these methods, risk of early femoral failure has been reduced below 0.1%. We are now also applying these protocols to stemmed total hip replacements in an effort to reduce our previous femoral fracture rate of 1.5%.