Changes in Bone Mineral Density and Femoral Neck Narrowing in the Proximal Femur Three to Five Years After Hip Resurfacing Versus Conventional Total Hip Arthroplasty

Gerhardt, Davey M J M; Smolders, José M.H.; Rijnders, Ton Ajm; Hol, Annemiek; Susante, Job L C van

doi:10.1016/j.arth.2014.09.007

Cited by 17 publications

(8 citation statements)

References 23 publications

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“…All these changes are characteristic of most comparable hip resurfacing femoral components (Amstutz, Beaulé et al 2004;Spencer et al 2008), and were under-predicted by the model if the established control algorithm was used with the literature standard 75% threshold remodelling stimulus. More extensive resorption was predicted if a smaller threshold remodelling stimulus of 62.5% was used, but this is in disagreement with quantitative clinical data which shows a clear loss-recovery trend in the lateral neck and a progressive BMD increase in the medial neck (Lian et al 2008), especially distal to the head-neck junction (Kishida et al 2004;Häkkinen et al 2011;Penny et al 2012;Gerhardt et al 2014). Quantitative comparison of the predicted and clinically measured BMD changes remains difficult with hip resurfacing implants, owing to the variety of DXA zone definitions in these cited studies.…”

Section: Discussionmentioning

confidence: 61%

“…For some time there was limited quantitative clinical evidence of periprosthetic BMD changes (Cohen and Rushton 1995;Wilkinson et al 2001), and only more recently has the availability of DXA data become sufficient to enable more thorough spatiotemporal assessment of the validity of these predictions across the full periprosthetic region: for cemented THR (Jayasuriya et al 2013), cementless THR (Leichtle et al 2005;Kim et al 2007;Penny et al 2012), and for hip resurfacing (Kishida et al 2004;Lian et al 2008;Häkkinen et al 2011;Penny et al 2012;Huang et al 2013;Gerhardt et al 2014). This data demonstrated that past modelling studies have not reproduced clinically representative temporal trends of remodelling.…”

Section: Introductionmentioning

confidence: 95%

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Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Dickinson

2015

Biomech Model Mechanobiol

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Bone morphology and density changes are commonly observed following joint replacement, and may contribute to the risks of implant loosening and periprosthetic fracture, and reduce the available bone stock for revision surgery. This study was presented in the "Bone and Cartilage Mechanobiology across the scales" WCCM symposium to review the development of remodelling prediction methods and to demonstrate simulation of adaptive bone remodelling around hip replacement femoral components, incorporating intrinsic (prosthesis) and extrinsic (activity and loading) factors.An iterative bone remodelling process was applied to finite element models of a femur implanted with a cementless THR (total hip replacement) and a hip resurfacing implant. Previously developed for a cemented THR implant, this modified process enabled the influence of pre-to postoperative changes in patient activity and joint loading to be evaluated. A control algorithm used identical pre-and postoperative conditions, and the predicted extents and temporal trends of remodelling were measured by generating virtual x-rays and DXA scans.The modified process improved qualitative and quantitative remodelling predictions for both the cementless THR and resurfacing implants, but demonstrated the sensitivity to DXA scan region definition and appropriate implant-bone position and sizing. Predicted remodelling in the intact femur in response to changed activity and loading demonstrated that in this simplified model, although the influence of the extrinsic effects were important, the mechanics of implantation were dominant. This study supports the application of predictive bone remodelling as one element in the range of physical and computational studies, which should be conducted in the pre-clinical evaluation of new prostheses.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 95%

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Dickinson

2015

Biomech Model Mechanobiol

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“…At the femoral side, specifically in the calcar region, an increase in BMD has been shown postoperative to RHA. 17,27,28 At the acetabular side an overall BMD decrease is seen, most distinctive medially to an uncemented cup. This might be indicative for load primarily concentrated at the periphery of the cup, resulting in a relative minor BMD losses in the cranial region and more pronounced BMD losses at the medial wall due to stress-shielding.…”

Section: Discussionmentioning

confidence: 99%

Changes in periacetabular bone mineral density five years after resurfacing hip arthroplasty versus conventional total hip arthroplasty

et al. 2018

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Introduction: We studied whether acetabular bone mineral density (BMD) is better preserved after resurfacing hip arthroplasty (RHA) versus small diameter metal-on-metal total hip arthroplasty (THA). Methods: This randomised controlled trial included 82 patients. BMD was measured in 5 periprosthetic regions of interest (ROI) with dual-energy absorptiometry (DEXA) preoperatively, at 3 and 6 months, 1, 2, 3 and 5 years postoperative. 34 RHA and 26 THA had a complete 5 years follow-up. 1 RHA and 1 THA were revised due to pseudotumour formation, 2 THA were revised because of recurrent dislocations and 1 RHA for avascular necrosis. Results: Overall an initial decrease in BMD was observed for both implants, stabilising after 2 years. 5 years after RHA a BMD change of +1% in upper cranial,-4% (p < 0.01) in cranial,-8% (p < 0.01) in craniomedial,-7% (p < 0.01) in medial and +4% in caudal ROI compared to baseline values was seen. 5 years after THA a BMD change of-3% (p = 0.01),-13% (p < 0.01),-21% (p < 0.01),-11% (p < 0.01) and-2% for each respective ROI. The observed BMD decrease in different regions was structurally favouring the RHA-cup, with significantly higher levels in the cranial and craniomedial ROI. Conclusion: Acetabular BMD is better preserved behind a rigid press-fit convex cup in RHA compared to a titanium threaded cup in conventional THA in the cranial and craniomedial ROI. Despite of a theoretical higher stress-shielding behind the stiff acetabular component in RHA, compared to the more elastic threaded titanium THA-cup, bone depletion behind the RHA component does not seem to be of major concern.

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“…Resurfacing hip arthroplasty (RHA) has been introduced to offer an alternative to conventional total hip arthroplasty (THA) with proposed bone stock preservation to facilitate future revision and to achieve a greater range of motion. Multiple studies report preservation of femoral bone mineral density (BMD) in the calcar with a good functional outcome in young patients at short-term follow-up (2–6).…”

Section: Introductionmentioning

confidence: 99%

Increase in Physical Activity after Resurfacing Hip Arthroplasty is Associated with Calcar and Acetabular Bone Mineral Density Changes

et al. 2017

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Changes in Bone Mineral Density and Femoral Neck Narrowing in the Proximal Femur Three to Five Years After Hip Resurfacing Versus Conventional Total Hip Arthroplasty

Cited by 17 publications

References 23 publications

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Changes in periacetabular bone mineral density five years after resurfacing hip arthroplasty versus conventional total hip arthroplasty

Increase in Physical Activity after Resurfacing Hip Arthroplasty is Associated with Calcar and Acetabular Bone Mineral Density Changes

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