Issues of full ROM and wear were the issues discussed with the patient, He had to continue with his Karate. His bone looked good being in a physically active person.
Dual mobility with ceramic head was selected.
Size 12 Evolutis stem, largest available in India was found to to stable on axial and torsional loading intraop and -3 head and Dual mobilty was used due to his extreme ROM requirement
He starts doing karate kicks 3 rd day in ward before discharge and sinks by 2 cm and now painless and short limped lurch. may be one should have cemented taking the risk of cementation in elderly. his canal was not stove pipe and felt good. Size 12 limitation may be an an indication for cement.
a cemented DUAl mobility like below would be the solution in soft bone. Collared corail stem might hold some value but could swing instead of sinking