Bone Density at the Proximal Femur After Total Hip Arthroplasty

Kröger, Heikki; Venesmaa, Petri; Jurvelin, Jukka S.; Miettinen, Hannu; Suomalainen, O; Alhava, Esko

doi:10.1097/00003086-199807000-00009

Cited by 96 publications

(122 citation statements)

References 28 publications

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“…A number of prospective studies of uncemented femoral implants have shown a significant bone loss (10-40%) in the calcar region after 1 4 years [S,lS, 23,26,27,30,34,35]. Our findings of the Unique stem are in agreement with this.…”

Section: Bone-mineral Densitysupporting

confidence: 90%

“…Some studies following patients up to 10 years have shown a progressive recovery or a minimal loss of BMD after the first to second postoperative year [ 16,20,30,34]. A different pattern of BMD changes has been found around loosened implants [9,23,31,32]. The importance of the early (1-2 years) bone resorption that we and others have found around fixed stems is not known.…”

Section: Bone-mineral Densitymentioning

confidence: 82%

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Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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The custom made Unique® stem is designed to fit closely to the metaphyseal region of the femur in order to obtain maximum mechanical stability and optimal load transfer. Thirty‐seven patients (38 hips) with non‐inflammatory arthritis were randomized to the uncemented custom made Unique® stem or the Elite Plus stem inserted with cement. The patients have been followed clinically as well as with radiostereometry (RSA) and Dual‐energy X‐ray Absorptiometry (DXA) for 2 years. After 2 years the RSA result showed minimal translation and rotation for the Unique® stem while the Elite Plus rotated slightly (mean 1.05°) into retroversion. Compared to previous studies the Elite Plus was as stable as the Charnley prosthesis. The DXA results showed a significantly higher proximal and total (10% for the Unique versus 5% for Elite) bone loss for the Unique® stem compared to the Elite Plus. Thus the optimal proximal press‐fit of the custom made stem did secure a stable fixation, but did not decrease the proximal bone loss. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Section: Bone-mineral Densitysupporting

confidence: 90%

Section: Bone-mineral Densitymentioning

confidence: 82%

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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show abstract

“…A large degree of bone loss of the proximal femur has been identified in longitudinal studies as early as 3-6 months after implantation of an uncemented stem; thereafter, the BMD stabilizes during the first postoperative year (Marchetti et al 1996, Nishii et al 1997, Wixson et al 1997, Kröger et al 1998. None of our patients were measured until 2 years after surgery.…”

Section: Discussionmentioning

confidence: 90%

Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2–7 years

et al. 2006

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Background Periprosthetic bone loss occurs around uncemented femoral stems and may be influenced by the stem size.Patients and methods We studied 138 consecutive patients, 3 (2-7) years on average after a total hip arthroplasty operation (THA) for unilateral osteoarthritis with the Bi-Metric uncemented femoral stem. We analyzed Harris hip score and bone mineral density.Results The mean Harris hip score was 97 at followup. Bone mineral density decreased proximally by 19% in both Gruen zones 1 and 7. Bone loss in zones 1, 2, 6, and 7 was significantly associated with stem size. Distally, a small gain in bone mass was found in zones 3 and 5 for medium femoral sizes.Interpretation We found a marked proximal BMD loss, especially for the larger stems, which may be specific for this particular implant. Long-term studies should reveal whether this proximal bone loss will affect the longevity of the THA.

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“…The main concern about the use of metallic implants, such as magnesium alloys, is the mismatch of Young's moduli of the implants and the adjacent bone tissue. This inconsistency between mechanical properties results in the inadequate loading of the bone that leads to bone stress shielding, can subsequently cause bone resorption, implant loosening, formation of cracks within the implant, and implant migration [77][78][79][80]. Thus, implants should have appropriate strength and stiffness matching those of bone tissue.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%