Changes in bone mineral density adjacent to two biomechanically different types of cementless femoral stems in total hip arthroplasty

Zerahn, Bo; Storgaard, Morten; Johansen, Torben; Olsen, Carsten Smith; Lausten, Gunnar Schwarz; Kanstrup, Inge‐Lis

doi:10.1007/s002640050247

Cited by 37 publications

(27 citation statements)

References 19 publications

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“…The pattern and the amount of any decrease in BMD seems to be strongly influenced by the stem design revealed by numerous DEXA studies with different femoral stems. At the calcar region a 28% mean loss of BMD has been reported with an extensively porous-coated stem [23], a 34% mean loss with a proximally porous-coated cobalt-chromium stem [17], 15-28% mean loss with proximally porous-coated titanium stems [17,53] and 20% with proximally porouscoated titanium supermodular stems [42]. The respective loss in calcar density was only 12% with titanium custom-made stems [51,53] and even some increase in the BMD of the calcar has been reported with stemless femoral implants [35].…”

Section: Five-year Radiological Resultsmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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We measured the post-operative radiological "fit and fill" of two different femoral stem designs, one with a straight proximally porous-coated n=50) and the other with a proximally anatomic, hydroxyapatite-coated and distally over-reamed stem (ABG, n=26). A comparison was then made between the clinical and radiological 5-year follow-up data of these two series and also of the bone remodeling changes around the stems. The observed differences in "fit and fill" parameters in the metaphyseal region were minute. However, in the diaphyseal bone the straight stem had substantially more cortical contact. The clinical results were excellent for both groups. Subsidence (>2 mm) was more frequent with the anatomical ABG stems, although the ABG stems had better bone ingrowth in the lower metaphyseal area. The present results indicate that the anatomical design may improve the fit and fill of a femoral stem in the metaphysis. On the other hand, a looser fill of the diaphyseal bone made the stems of this type more susceptible to subsidence. The straight stem with tight diaphyseal fit showed excellent stability, but the good bone ingrowth and remodeling around the distal part of the stem indicates stress transfer through this region and increased stress shielding of the proximal metaphyseal femur.Résumé Nous avons mesuré l'adaptation et le remplissage radiographique postopératoire de deux modèles diffé-rents de tiges fémorales, une tige droite avec la porosité proximale (BI-Metric, n=50) et une tige proximalement anatomique revêtue d'hydroxyapatite avec un surfaçage distal (ABG, n=26). Nous avons comparé les renseignements cliniques et radiographiques de ces deux séries de données résultant d'un suivi de cinq ans. Le remodelage osseux autour des tiges a été pris en compte. Les diffé-rences observées dans les paramètres de l'adaptation et de remplissage dans la région métaphysaire étaient minimales. Par contre dans la région diaphysaire la tige droite faisait montre de plus de contact cortical et ceci d'une manière significative. Les résultats cliniques sur ces deux groupes furent excellents. L'enfoncement (>2 mm.) de tiges anatomiques ABG était plus fréquent. Les résul-tats présentés indiquent que le modèle anatomique pourrait améliorer l'adaptation et le remplissage de la tige fé-morale dans la région de l'os métaphysaire.

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Section: Five-year Radiological Resultsmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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“…The design and geometry of the prosthesis play a role in the pattern or distribution of such loads along the femur [22,24,27], and it is safe to say that the early stability achieved with a lateral flare geometry and the maximization of load transfer to the proximal femur seem to explain the particular pattern of bone remodelling, with maintenance of bone mass in loaded areas (Wolff's law).…”

Section: Discussionmentioning

confidence: 99%

Promising mid-term results of total hip arthroplasties using an uncemented lateral-flare hip prosthesis: a clinical and radiographic study

Leali

Fetto

2007

International Orthopaedics (SICO

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The clinical results after total hip replacements using noncemented stems have shown considerable variability over the years; the design and characteristics of the implant seemed to play a role in explaining this fact. The purpose of this paper is to report the clinical, radiographic and densitometry results of total hip arthroplasties using a stem designed for noncemented implantation and to engage and load the femur proximally. Fifty-eight consecutive patients (62 hips) followed for an average of 4.3 years (range 36-70 months) were clinically and radiographically followed up at three weeks, three months, six months, one year, and yearly thereafter. The average pre-operative Harris hip score was 49 increasing to 98 at the latest follow-up. There were no cases of aseptic or septic loosening. The average subsidence at three years was 0.45 mm (SD±0.36 mm). Radiographically all hips were classified as stable, and evident changes compatible with new bone apposition were observed in 64% of the cases. The extended proximal geometry of the device seems to favour initial and secondary stability as reflected by the low subsidence values over time. The maintenance of periprosthetic bone stock and the absence of stress shielding can be explained by the predominantly proximal loading pattern of the stem.Résumé Les résultats cliniques des arthroplasties totales de hanche utilisant des tiges non-cimentées ont été très variables au cours des années, les caractéristiques de l'implant semblant jouer un rôle important. Le but de ce travail est de rapporter les résultats cliniques et radiologiques d'arthroplasties avec une tige non-cimentée avec appui proximal. 58 patients consécutifs (62 hanches) suivi en moyenne pendant 4,3 ans (36 à 70 mois) étaient étudiés à 3 semaines, 3 mois, 6 mois, 1 an puis tous les ans. Le score moyen de Harris pré-opératoire était de 49, augmentant à 98 au dernier examen. Il n'y avait pas de descellement aseptique ou septique. L'enfoncement moyen à 3 ans était de 0,45 mm (SD 0,36 mm). Radiologiquement toutes les hanches étaient stables et des modifications compatibles avec une ostéoformation était visible dans 64% des cas. La géométrie proximale de la tige semble favoriser la stabilité initiale et secondaire comme le montre le faible enfoncement au fil du temps. La conservation du stock osseux et l'absence de déviation des contraintes peuvent s'expliquer par la mise en charge proximale de la prothès.

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“…Such findings may reduce proximal stress shielding and provide a circumferential barrier to wear debris that induces osteolysis [1,14]. DXA studies have reported proximal bone resorption around uncemented stems, which can range from 20 to 50% [5,14,20,24]. Structural differences of cortical and cancellous bone are not taken into consideration when measuring BD after THA with DXA [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…DXA studies have reported proximal bone resorption around uncemented stems, which can range from 20 to 50% [5,14,20,24]. Structural differences of cortical and cancellous bone are not taken into consideration when measuring BD after THA with DXA [24,25]. Using sectional CT imaging, a separate analysis of cortical and cancellous bone structures can be achieved [17,18].…”

Section: Discussionmentioning

confidence: 99%

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Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

Pitto

Bhargava

Pandit

et al. 2007

International Orthopaedics (SICO

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The aim of this prospective study was to measure bone density changes and to assess adaptive bone remodelling after uncemented total hip arthroplasty with a taper-design femoral component using quantitative computer-tomographyassisted osteodensitometry. This method is able to differentiate cortical and cancellous bone structures. Twenty-seven consecutive patients (29 hips) with degenerative joint disease were enrolled in the study. Serial clinical, radiological and CTosteodensitometry assessments were performed after the index operation. At the 2-year follow-up, the clinical outcome was rated satisfactory in all hips. The radiological assessment showed signs of osteointegration and stable fixation of all cups and stems. We observed a −17% decrease of cortical bone density and −22% decrease of cancellous bone density in the greater trochanter and femoral neck region. Cortical and cancellous bone density decrease at the level of the lesser trochanter was −9% and respectively −4%. We observed small changes of cortical bone density in the diaphyseal regions; in contrast, cancellous bone density increased (range 6% to 27%) in the diaphyseal regions. Overall, a trend of bone density recovery was observed throughout the follow-up period. Periprosthetic bone density changes at the 2-year follow-up are suggestive of stable osteointegration with proximal femoral diaphysis load transfer and moderate metaphyseal stress-shielding.Résumé Le but de cette étude prospective est de mesurer par scanner et ostéodensitométrie la densité osseuse et le remodelage osseux après prothèse non cimentée. Cette méthode permet de différencier les structures osseuses corticales et spongieuses. 27 patients consécutifs (29 hanches) présentant une coxarthrose ont été inclus dans cette étude qui a comporté une analyse radiologique, scanographique et ostéo-densitométrie. Pour toutes les hanches à deux ans de suivi post-opératoire, le devenir clinique de ces patients était satisfaisant. La radiologie montrait des signes d'ostéointégra-tion et de fixation stables dans toutes les cupules et pour toutes les pièces fémorales. Nous avons observé une diminution de 17% de la densité corticale et de 22% de la densité de l'os spongieux au niveau du grand trochanter et au niveau du calcar. Il existe également une diminution de la densité osseuse au niveau du petit trochanter tant sur le plan cortical 9% qu'au niveau de l'os spongieux 4%. Nous avons égale-ment observé de petites modifications de la densité osseuse corticale au niveau de la région diaphysaire, a contrario nous avons également mis en évidence une augmentation de la densité osseuse de l'os spongieux à ce niveau (de 6 à 27%). Ces différentes modifications osseuses nous permettent, à deux ans de suivi post-opératoire, de penser que l'ostéointégration proximale des éléments prothétiques entraîne un transfert de charge et un stress-shielding métaphysaire modéré.

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Changes in bone mineral density adjacent to two biomechanically different types of cementless femoral stems in total hip arthroplasty

Cited by 37 publications

References 19 publications

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Promising mid-term results of total hip arthroplasties using an uncemented lateral-flare hip prosthesis: a clinical and radiographic study

Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

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