Densitometric evaluation of bone remodelling around Trabecular Metal Primary stem: a 24-month follow-up

Gasbarra, Elena; Iundusi, Riccardo; Perrone, Fabio Luigi; Saturnino, Luca; Tarantino, Umberto

doi:10.1007/s40520-015-0424-2

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…This has been observed by several authors of studies conducted with short stem implants. 29,34,35 As was observed in the current study, these bony alterations occurred within the first couple of months after implantation and then stopped, 2,31,[36][37][38] suggesting that it is an answer to changes in loading conditions. This questions the proximal fixation of this trochanter sparing short stem and leads to think that it may function more like a shorter straight stem with distal load transfer than a short stem with proximal load transfer.…”

Section: Discussionsupporting

confidence: 78%

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

et al. 2019

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Background: Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. Methods: 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29–89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. Results: 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1–99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2–70), 18 (SD 12.1, range -10–43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. Discussion: This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

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Section: Discussionsupporting

confidence: 78%

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

et al. 2019

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“…Due to the limited evidence retrieved on BMD measurements in lower limb amputees rehabilitated using OI, a supplementary table was generated to summarise studies reporting BMD measurements in patients who received an osseointegrated prosthesis for hip or knee joint replacement procedures (THA and TKA; Table SII). Many of these supplementary studies on both THA and TKA reported an overall decrease in BMD for all measured regions of interest (ROIs) (30)(31)(32)(33)(34)(35). In addition, others found variations in BMD changes from no change to decreased BMD post-surgery in different ROIs (36,37).…”

Section: Bmd Measurements For Oi In Amputeesmentioning

confidence: 99%

Bone mineral density in osseointegration implant surgery: A review of current studies (Review)

Carr,

Pedagandham,

Giugni

et al. 2024

Biomed Rep

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Osseointegration implant (OI) surgery is the latest rehabilitation technology for amputees, where a bone-anchored implant obviates the limitations of traditional socket prostheses. The bone mineral density (BMD) in the periprosthetic and other anatomical regions can be used to assess bone remodelling following OI surgery. Currently, limited studies have used BMD measurements in reporting post-operative OI outcomes and the association between the maintenance of BMD and implant efficacy has remained elusive. This review captured and analysed all studies that have reported the BMD as an objective outcome measure in patients with trans-femoral or trans-tibial OI. The PubMed, Medline, Scopus and Web of Science databases were searched using the terms ‘amputation’, ‘osseointegration’ and ‘bone mineral density’. A total of 6 studies involving human participants were included for analysis. All studies used dual X-ray absorptiometry and/or X-rays for measuring BMD. Rehabilitation of trans-femoral or trans-tibial amputation using OI may help restore healthy BMD by enabling physiological bone loading. However, there is a low correlation between the BMD around the OI and the success of OI surgery or the risk of periprosthetic fractures. This review summarises the current evidence on BMD assessment in OI for lower limb amputee rehabilitation. Despite the great variability in the results, the available evidence suggests that OI may help restore BMD following surgery. The limited evidence calls for further investigation, as well as the development of a standard BMD measurement protocol.

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“…The value MRI can add to BMD is that it can predict the strength of cancellous bone in addition to the bone quality change [14]. It is worth mentioning that BMD can be assessed using dual energy X-ray absorptiometry (DEXA) which was reported to be the most accurate and reliable technique for the assessment of BMD [15]. Qualitative and quantitative information that can be used for Finite Elements Analysis [16] Another view to consider is the suggestion, made by Porrelli et al [16], that morphological information cannot be extracted from DEXA and ultrasonography alone in a qualitative and quantitative manner.…”

Section: Diagnostic Toolsmentioning

confidence: 99%

A Review of Conventional and Novel Treatments for Osteoporotic Hip Replacements

et al. 2023

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Introduction: Osteoporosis is a skeletal disease that severely affects the mechanical properties of bone. It increases the porosity of cancellous bone and reduces the resistance to fractures. It has been reported in 2009 that there are approximately 500 million osteoporotic patients worldwide. Patients who suffer fractures due to fragility cost the National Healthcare Systems in the United Kingdom £4.4 billion in 2018, in Europe €56 billion in 2019, and in the United States $57 billion in 2018. Thus, osteoporosis is problematic for both patients and healthcare systems. Aim: This review is conducted for the purpose of presenting and discussing all articles introducing or investigating treatment solutions for osteoporotic patients undergoing total hip replacement. Methods: Searches were implemented using three databases, namely Scopus, PubMed, and Web of Science to extract all relevant articles. Predetermined eligibility criteria were used to exclude articles out of the scope of the study. Results: 29 articles out of 183 articles were included in this review. These articles were organised into three sections: (i) biomechanical properties and structure of osteoporotic bones, (ii) hip implant optimisations, and (iii) drug, cells, and bio-activators delivery through hydrogels. Discussion: The findings of this review suggest that diagnostic tools and measurements are crucial for understanding the characteristics of osteoporosis in general and for setting patient-specific treatment plans. It was also found that attempts to overcome complications associated with osteoporosis included design optimisation of the hip implant; however, only short-term success was reported, while the long-term stability of implants was compromised by the progressive nature of osteoporosis. Finally, it was also found that targeting implantation sites with cells, drugs, and growth factors has been outworked using hydrogels, where promising results have been reported regarding enhanced osteointegration and inhibited bacterial and osteoclastic activities. Conclusions: These results may encourage investigations that explore the effects of these impregnated hydrogels on osteoporotic bones beyond metallic scaffolds and implants.

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Densitometric evaluation of bone remodelling around Trabecular Metal Primary stem: a 24-month follow-up

Abstract: At the present time, DEXA is considered the most reliable tool for evaluating bone remodelling after THA.

Cited by 8 publications

References 24 publications

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

Bone mineral density in osseointegration implant surgery: A review of current studies (Review)

A Review of Conventional and Novel Treatments for Osteoporotic Hip Replacements

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