Ambulatory Activities Maintain Cortical Bone after Total Hip Arthroplasty

Rosenbaum, Teri G.; Bloebaum, Roy D.; Ashrafi, Shadi; Lester, D. Kevin

doi:10.1097/01.blo.0000223981.21584.35

Cited by 18 publications

(16 citation statements)

References 43 publications

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“…There is evidence, however, that the proximal canal that surrounds the distal portion of the stem is maintained or even enhanced with time: some studies showed cortical enlargement with limited quantitative loss of BMC in these regions [1,11]. In the case of femoral revision arthroplasty, this preservation of bone stock could be valued as favorable [1,17,21].…”

Section: Discussionmentioning

confidence: 99%

Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

Stiehl

2009

Clinical Orthopaedics &Amp; Related Research

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Although periprosthetic changes after THA have been well documented in short-term studies of less than 5 years, little is known about long-term changes. Long-term mineral changes must be evaluated against an unaffected limb control and for regional differences about a prosthesis. This study evaluated long-term periprosthetic remodeling using dual-energy xray absorptiometry in a prospective study of patients who had noncemented THAs with a modular titanium alloy proximal-loading prosthesis. In 15 randomly selected patients, bone mineral content was measured within 15 months of surgery and then at late mean followup of 13 years. In the affected femur, there was a major decrease in periprosthetic bone mineral content in Zones 1, 2, 6, and 7 (Gruen et al.) over the course of the study. The overall decrease in Zone 7 was 39% in bone mineral content. Estimates made after controlling for the contralateral unaffected femur indicate a major loss only in Zone 7 and preservation of mineral content in Zones 3, 4, and 5 of the proximal femur. The data suggest bone remodeling maintains the overall structural integrity of the upper femoral shaft.

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Section: Discussionmentioning

confidence: 99%

Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

Stiehl

2009

Clinical Orthopaedics &Amp; Related Research

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“…On the other hand, these knees maximize the functional outcome that can possibly lead to an increase in overall number of GCs taken in the real world. This might prevent bone loss around the fixation [51] while accelerating fatigue of fixation parts [36][37]. However, altogether, a microprocessor-controlled knee might provide the best compromise between gain in functional outcomes, promoting bone health, and risks of fracture.…”

Section: Prosthesismentioning

confidence: 99%

Load applied on bone-anchored transfemoral prosthesis: Characterization of a prosthesis� A pilot study

Frossard¹,

Häggström²,

Hagberg³

et al. 2013

JRRD

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Abstract-The objectives of this study were to (1) record the inner-prosthesis loading during activities of daily living (ADLs), (2) present a set of variables comparing loading data, and (3) provide an example of characterization of two prostheses. The load was measured at 200 Hz using a multi-axial transducer mounted between the residuum and the knee of an individual with unilateral transfemoral amputation fitted with a bone-anchored prosthesis. The load was measured while using two different prosthetic knees, mechanical (PRO1) and microprocessor-controlled (PRO2), during six ADLs. The characterization of the prostheses was achieved using a set of variables split into four categories, including temporal characteristics, maximum loading, loading slopes, and impulse. Approximately 360 gait cycles were analyzed for each prosthesis. PRO1 showed a cadence improved by 19% and 7%, a maximum force on the long axis reduced by 11% and 19%, and an impulse reduced by 32% and 15% during descent of incline and stairs compared with PRO2, respectively. This work confirmed that the proposed apparatus and characterization can reveal how changes of prosthetic components are translated into inner-prosthetic loading.

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“…Multiple factors are involved in the aetiology of bone loss and fixation failure following THA [13]. These include stress shielding, age, wear debris, osteolysis and micromotion of the implant.…”

Section: Resultsmentioning

confidence: 99%

“…Rosenbaum et al [13] investigated the relationship between physical activity, BMD and cross-sectional cortical bone area following THA. They studied cadaveric femurs from patients who had undergone THA during their lifetime.…”

Section: Mechanical and Histological Correlationmentioning

confidence: 99%

“…Changes in both cortical and cancellous bone density following stress shielding of the bone may contribute to aseptic loosening, especially in conjunction with polyethylene wear [13,15]. Stress shielding occurs as the physiological loads applied to bone are altered by the placement of an implant with a different stiffness to that of the host bone in which it is implanted.…”

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confidence: 99%

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Quantitative computer-assisted osteodensitometry in total hip arthroplasty

Pitto

Mueller

Reilly

et al. 2006

International Orthopaedics (SICO

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Several factors can cause bone loss and fixation failure following total hip arthroplasty (THA), including polyethylene wear debris, implant micromotion and stress shielding. Various techniques have been used in an effort to detect bone density loss in vivo, all with varying success. Quantitative computed tomography (qCT)-assisted osteodensitometry has been shown to be useful in assessing the in vivo structural bone changes after THA. It has a high resolution, accuracy and reproducibility, thereby making it a useful tool for research purposes, and it is able to differentiate between cortical and cancellous bone structures and assess the bone/implant interface. This technique also provides valuable information about the pattern of stress shielding which occurs around the prosthesis and can show early bony changes, which may prove informative about the quality of implant fixation and surrounding bone adaptation. In conjunction with finite-element analysis, qCT is able to generate accurate patient-specific meshes on which to model implants and their effect on bone remodelling. This technology can be useful to predict bone remodelling and the quality of implant fixation using prostheses with different design and/or biomaterials. In the future, this tool could be used for pre-clinical validation of new implants before their introduction in the market-place.Résumé Plusieurs facteurs peuvent causer une perte osseuse et la faillite de la fixation après une arthroplastie totale de la hanche. Ils incluent les débris de polyéthylène, la micromobilité des implants et le transfert de contraintes. Plusieurs techniques ont été utilisées pour détecter la perte de densité osseuse, avec des succés variés. L'ostéodensitométrie quantitative par scanner s'est montrée utile dans l'étude in vivo des modifications structurales osseuses après arthroplastie totale de la hanche. Elle a une haute résolution, une précision et une reproductibilité qui en font un outil approprié pour la recherche. L'ostéodensitométrie quantitative peut différen-cier l'os cortical et l'os spongieux, étudier l'interface osimplant et donner des informations sur le modèle de déviation des contraintes qui surviennent autour d'une prothèse. Elle peut montrer précocement des modifications osseuses, ce qui renseigne sur la qualité de la fixation des implants et l'adaptation de l'os voisin. En conjonction avec l'analyse par éléments finis elle peut générer un maillage précis spécifique du patient permettant l'étude de modèles d'implants et leur effet sur le remodelage osseux. Cette technologie peut être utile pour prévoir le remodelage osseux et la qualité de la fixation pour des prothèses de différentes formes et/ou matériaux. Dans le future cet outil pourra être utilisé pour la validation pré-clinique de nouveaux implants avant leur introduction sur le marché.

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Ambulatory Activities Maintain Cortical Bone after Total Hip Arthroplasty

Cited by 18 publications

References 43 publications

Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

Load applied on bone-anchored transfemoral prosthesis: Characterization of a prosthesis� A pilot study

Quantitative computer-assisted osteodensitometry in total hip arthroplasty

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