Bone Remodelling after Total Hip Arthroplasty Using an Uncemented Anatomic Femoral Stem: A Three-Year Prospective Study Using Bone Densitometry

Jj, Panisello; Herrero, L.; Herrera, Antonio; Canales, V.; Martı́nez, Amalia; Cuenca, Jorge

doi:10.1177/230949900601400108

Cited by 58 publications

(52 citation statements)

References 25 publications

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“…Finally, without serial measurements it is not possible to determine when these changes occurred and whether they had stabilized, only that they had occurred at the time of the final scan. Although periprosthetic bone changes have been consistently documented by most other DEXA studies, what has remained unknown is the long-term BMC about the entire prosthesis [2,10,11,19]. The data show BMC does not diminish in the upper femoral shaft compared with the normal unaffected control and this is the most important finding.…”

Section: Discussionsupporting

confidence: 64%

“…It would be inappropriate to make generalizations about the particular implant used in this study or even to make greater conclusions regarding all uncemented femoral prostheses. However, the overall changes documented in this study reflect general trends that have been documented in the literature by shorter followup periods [2,4,9,18,19] ( Table 4). Evaluating longitudinal changes in bone mineral density with DEXA can be problematic.…”

Section: Discussionmentioning

confidence: 43%

“…Long-term changes are likely from stress shielding, but their importance must be balanced against changes that normally would occur in this population of patients. Some authors suggest stress shielding may be minimized by a low-modulus, intimately fit, proximally fixed device that does not bypass the proximal medial regions with distal fixation [10,18,19]. That hope was not validated by the device used in this study.…”

Section: Discussionmentioning

confidence: 54%

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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: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 54%

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Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

Stiehl

2009

Clinical Orthopaedics &Amp; Related Research

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“…Thus, our aim was to investigate whether the cementless Bicontact® straight stem used in our department in its unaltered form for 20 years provides criteria for a stateof-the art stem regarding proximal bone stock preservation. This can be determined by DEXA, which is the most reliable tool for evaluating bone remodelling after THA using different stem designs [21,22].…”

Section: Discussionmentioning

confidence: 99%

The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study

Lerch

Kurtz

Bouguecha

et al. 2012

International Orthopaedics (SICOT)

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Purpose The cementless Bicontact® total hip arthroplasty (THA) system (AESCULAP AG, Tuttlingen, Germany) was introduced in 1986/1987 and has been in successful clinical use in an unaltered form up to today. Although good longterm results with the Bicontact® stem have been published, it is questionable whether the implant provides the criteria for a state-of-the-art stem regarding proximal bone stock preservation. The purpose of the study was to monitor the periprosthetic bone mineral density (BMD) in a prospective two-year follow-up dual-energy X-ray absorptiometry (DEXA) study. Methods After power analysis, a consecutive series of 25 patients with unilateral Bicontact® stem implantation was examined clinically and underwent DEXA examinations. Scans of seven regions of interest were taken preoperatively and at one week, six months, and one and two years. Results One patient required stem revision due to a deep infection. The Harris Hip Score increased significantly by 44 points. The most significant bone loss was observed in the calcar region (R7) in the first six months (−19.2 %). It recovered in the following 18 months to −8.5 %. The BMD in the greater trochanter dropped significantly after six months and remained stable at this level. BMD exceeded baseline values in distal regions and even more in the lesser trochanter region after two years. Conclusions We conclude that the Bicontact® stem provides adequate proximal bone stock preservation. We observed some signs of stress shielding at the tip of the stem, which is inevitable to some degree in THA with cementless straight stems. However, in this prospective DEXA investigation, we showed that proximal off-loading does not occur after THA with the Bicontact® system. Thus, we believe that this stem is still a state-of-the-art implant.

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“…It can be seen that for both stems, the maximum decrease in bone mass occurred in Zone 7. This decrease in bone mass is greater in the Versys model than in the ABG stem Prior to the development of our FE models several long-term studies of bone remodeling after the implantation of two different cementless stems, ABG I and ABG II, were performed (Panisello et al, 2006;Panisello et al, 2009a;Panisello et al, 2009b). These studies were performed using DEXA, a technique that allows an accurate assessment of bone density losses in the different Gruen zones (Fig.…”

Section: Finite Element Analysis 134mentioning

confidence: 99%