Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty

Brodner, Wolfram; Bitzan, Peter; Lomoschitz, F.; Krepler, P; Jankovsky, R.; Lehr, Stephan; Kainberger, Franz; Gottsauner‐Wolf, Florian

doi:10.1302/0301-620x.86b1.14637

Cited by 129 publications

(91 citation statements)

References 33 publications

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“…Further scans were taken six months and one and two years after index surgery to obtain data from the most active period of bone remodelling [25,26]. Although many factors are known to influence periprosthetic BMD [3], stem design and fixation are the most important [27]. In agreement with previous studies, we observed a strong decrease in BMD for almost all regions.…”

Section: Discussionsupporting

confidence: 86%

“…This can be ascribed to blood-flow disruption due to femoral canal preparation three to six months after surgery [28]. The major BMD decreases in the greater trochanter (R1) and the calcar (R7) are typical for straight stems [3,21,23,25,27,[29][30][31][32]. They occur mostly due to stress shielding in the very proximal portion of the calcar due to the vast proximal cross section of the implant [28,31].…”

Section: Discussionmentioning

confidence: 99%

“…However, virtually every new stem comes up to the claim of "preserving bone" by cementless proximal fixation and proximal load transfer to the bone. This can be assessed by direct acquisition of bone remodelling data via dual-energy X-ray absorptiometry (DEXA), which is the gold standard in evaluating redistribution of mechanical forces and femur remodelling around the THA implant [3]. Although good long-term results with the Bicontact® stem have been published [1,2,4], it is questionable whether the implant provides the criteria for a state-of-the-art stem regarding proximal bone stock preservation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…1), a higher incidence than that obtained with femoral stems fixed either proximally [19] or distally [1,16] or even with HAcoated implants [4]. In contrast to the findings of Engh et al [6] with AML implants, progressive proximal bone resorption did not stop after the two year follow-up but increased continuously (Fig.…”

Section: Discussionmentioning

confidence: 78%

Ten-year follow-up of an anatomical hydroxyapatite-coated total hip prosthesis

Cortés

Sebastiá

Herrera

et al. 2006

International Orthopaedics (SICO

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We report our results after ten year follow-up of 107 consecutive ABG-I hip prostheses implanted between June 1990 and December 1992: Only 84 prostheses were still in the study after ten years, but only six patients had undergone surgical revision. We can consider our clinical outcomes as excellent, with a whole-implant survival rate greater than 96%, a mean Merle D'Aubigne and Postel score increasing from 7.97 before operation to 16.17 at ten year follow-up, and a personal subjective assessment as excellent or good in 82.14% of patients. However, radiographic outcomes are more worrying: around 90% of patients show a stress-shielding phenomenon and granulomatous lesions in the proximal femur, and more than 82% suffer polyethylene wear greater than one millimetre (mean 1.68 mm). We think that zirconia stem heads and hooded antiluxation PE inserts are determining factors in the process of PE wear and, secondarily, in cancellous bone resorption and bone osteolysis.

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“…This corresponds with loss of proximal trabecular bone mineral density (BMD) and cortical thickness (Brodner et al 2004;Chandran et al 2012;Stucinskas et al 2012;Jayasuriya et al 2013), distal cortical thickening (Abadie et al 2010), and in cementless implants the formation of trabecular pedestal features (Slack et al 2006). In resurfacing hip replacement (RHR), replacement of the femoral articular cartilage and a layer of supporting bone with a stiff metal shell leads to cancellous bone resorption inside the femoral head and a narrowing of the femoral neck at its junction with the head.…”

Section: Introductionmentioning

confidence: 99%

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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Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty

Cited by 129 publications

References 33 publications

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

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

Ten-year follow-up of an anatomical hydroxyapatite-coated total hip prosthesis

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

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