Bone Remodelling around A Cementless Straight Tha Stem: A Prospective Dual-Energy X-Ray Absorptiometry Study

Stukenborg-Colsman, Christina; Haar-Tran, Annelene von der; Windhagen, Henning; Bouguecha, Anas; Wefstaedt, Patrick; Lerch, Matthias

doi:10.5301/hip.2012.9227

Cited by 25 publications

(20 citation statements)

References 25 publications

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“…This pattern agrees well with StukenborgColsman's observation reporting that after a progressive bone loss in zone 7 during the first 6 months postoperation, BMD increased and recovered slightly by 7% at the end of the first year [21]. Therefore, this study suggests that the periprosthetic bone loss is not necessarily progressive and even restoration of bone density can occur, analogous to the observations of Trevisan et al and Wixson et al [63,64].…”

Section: Discussionsupporting

confidence: 93%

“…11). Similarly, in Stukenborg-Colsman's clinical examination, using a Ti alloy implant, the strongest decreases in BMD were observed in zone 7 (--12%) and zone 1 (-11%) [21]. In Turner's work simulating bone remodeling process after THA with a CoCr implant (Epoch), the maximum bone loss of -10% was seen in zone 7 after 2yr postOperation [7].…”

Section: Fig 11 Grapli Showing Changes In the Average Bone Density Imentioning

confidence: 98%

“…To investigate bone loss, many researchers have measured the bone mineral density (BMD) after THA using dual energy X-ray absorptiometry [18][19][20][21]. Since it is not always feasible to follow-up the long-term behavior of the bone in response to implantation, it is important to develop realistic models to predict the bone evolution and thus monitor bone remodeling.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model

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Klika

Bougherara

2014

Journal of Biomechanical Engineering

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Periprosthetic bone loss following total hip arthroplasty (THA) is a serious concern leading to the premature failure of prosthetic implant. Therefore, investigating bone remodeling in response to hip arthroplasty is of paramount for the purpose of designing long lasting prostheses. In this study, a thermodynamic-based theory, which considers the coupling between the mechanical loading and biochemical affinity as stimulus for bone formation and resorption, was used to simulate the femoral density change in response to THA. The results of the numerical simulations using 3D finite element analysis revealed that in Gruen zone 7, after remarkable postoperative bone loss, the bone density started recovering and got stabilized after 9% increase. The most significant periprosthetic bone loss was found in Gruen zone 7 (-17.93%) followed by zone 1 (-13.77%). Conversely, in zone 4, bone densification was observed (+4.63%). The results have also shown that the bone density loss in the posterior region of the proximal metaphysis was greater than that in the anterior side. This study provided a quantitative figure for monitoring the distribution variation of density throughout the femoral bone. The predicted bone density distribution before and after THA agree well with the bone morphology and previous results from the literature.

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Section: Discussionsupporting

confidence: 93%

Section: Fig 11 Grapli Showing Changes In the Average Bone Density Imentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model

Avval

Klika

Bougherara

2014

Journal of Biomechanical Engineering

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“…A flat, rectangular stem shape, lateral fixation fins and a dorsal antirotation wing give the stem primary stability and proximal force transmission exclusively in the intertrochanteric region. Distal pressfit is expressively not intended with this design [7] (Fig. 2).…”

Section: Methodsmentioning

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 has a flat, rectangular shape, lateral fixation fins and a dorsal antirotation wing to give the stem primary stability and proximal force transmission in the intertrochanteric region [5,6]. The ten to 15-year results of Bicontact® uncemented THA show satisfactory pain relief, good functional results and durable implant stability with excellent stem survival.…”

Section: Methodsmentioning

confidence: 99%

Numeric simulation of bone remodelling patterns after implantation of a cementless straight stem

Lerch

Stukenborg-Colsman

Kurtz

et al. 2013

International Orthopaedics (SICOT)

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Purpose For further development of better bone-preserving implants in total hip arthroplasty (THA), we need to look back and analyse established and clinically approved implants to find out what made them successful. Finite element analysis can help do this by simulating periprosthetic bone remodelling under different conditions. Our aim was thus to establish a numerical model of the cementless straight stem for which good long-term results have been obtained. Methods We performed a numeric simulation of a cementless straight stem, which has been successfully used in its unaltered form since 1986/1987. We have 20 years of experience with this THA system and implanted it 555 times in 2012. We performed qualitative and quantitative validation using bone density data derived from a prospective dualenergy X-ray absorptiometry (DEXA) investigation. Results Bone mass loss converged to 9.25 % for the entire femur. No change in bone density was calculated distal to the tip of the prosthesis. Bone mass decreased by 46.2 % around the proximal half of the implant and by 7.6 % in the diaphysis. The numeric model was in excellent agreement with DEXA data except for the calcar region, where deviation was 67.7 %. Conclusions The higher deviation in the calcar region is possibly a sign of the complex interactions between the titanium coating on the stem and the surrounding bone. We developed a validated numeric model to simulate bone remodelling for different stem-design modifications. We recommend that new THA implants undergo critical numeric simulation before clinical application.

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Bone Remodelling around A Cementless Straight Tha Stem: A Prospective Dual-Energy X-Ray Absorptiometry Study

Cited by 25 publications

References 25 publications

Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model

Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model

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

Numeric simulation of bone remodelling patterns after implantation of a cementless straight stem

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