Determination of periprosthetic bone density with the DEXA method after implantation of custom-made uncemented femoral stems

Martini, F.; Sell, Stefan; Kremling, Elisabeth; Küsswetter, W.

doi:10.1007/s002640050067

Cited by 37 publications

(30 citation statements)

References 9 publications

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“…Therefore, the use of frontal-plane regions of interests like the Gruen zones is not suitable for qCT. Several studies have reported the highest levels of BD resorption in Gruen zones 1 or 7, which corresponds with our most proximal scan around the greater trochanter and femoral neck, where we also found the highest levels of cancellous and cortical BD loss (ROI 1 and 2) [5,10]. Other studies have reported a BD loss of greater than 50% in the calcar region [14,25].…”

Section: Discussionmentioning

confidence: 52%

“…Finiteelement analyses showed that the extent of stress shielding is directly correlated to stem stiffness, with lower E-modulus materials like titanium-reducing proximal stress shielding [6,21]. HA-coated implants show a good clinical and radiological outcome with moderate BD loss and improved implant fixation when compared with porous-coated implants [10,18,20]. Histological analyses in cadaveric specimens have shown sound proximal and distal HA stem-bone osteointegrations in a relatively short period after THA [1].…”

Section: Discussionmentioning

confidence: 99%

“…Bone density (BD) assessment using dual energy X-ray absorptiometry (DXA) has been used to monitor bone remodelling changes after THA [10,24,25]. The major disadvantage of DXA is the inability to differentiate between cortical and cancellous bone.…”

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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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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Moreover, while only two-dimensional surface determinations are possible with conventional DXA, three-dimensional assessment of the bone is possible with CT-assisted osteodensitometry. In the present study using CT-assisted bone mineral densitometry, less bone resorption (approximately -20% for cortical and cancellous BD) was found in the proximal part of the femur when compared to similar measurements made with DXA (-35% for Gruen zones 1 and 7) [7,8]. These findings probably result from the type of implant used in our study, particularly its tapered design.…”

Section: Discussionsupporting

confidence: 35%

A computed tomography assessment of femoral and acetabular bone changes after total hip arthroplasty

Schmidt

Müller

Kreß

et al. 2002

International Orthopaedics

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Using computed tomography-assisted (CT) osteodensitometry, we studied the bone changes that occurred in 12 patients at 2 weeks and again at 1 year after total hip arthroplasty with insertion of a press-fit acetabular cup and an uncemented femoral tapered stem. There was a greater decrease in full bone density (BD) lateral to the femoral stem when compared to the medial side, at the proximal end of the femur this difference was significant (-22.1% versus -16.2%) (P<0.001). At the tip of the stem cortical BD had decreased between 2.3% and 1.9% only. Proximal to the cup, the cortical BD increased by about 3.4% (P≤0.05), while the full BD decreased markedly by 8% (P≤0.001). These changes represent a response to a decrease in regional bone stress induced by the presence of the press-fit implant, and this might be considered as retro-acetabular stress shielding. No focal bone resorption was found.

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“…Tapered femoral components had a proximal loss between 10% to 30% [1,6,19]. Custommade implants reported the best results regarding the proximal loss of BMD, but with a fall of between 10% to 15% at the end of the third year [12,13]. Recently, femoral stems with reduced stiffness showed a 15% reduction of BMD in the calcar at the end of the second year [7,9,16].…”

Section: Discussionmentioning

confidence: 99%

Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem

Panisello

Canales

Herrero

et al. 2008

International Orthopaedics (SICOT)

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The aim of this prospective cohort study was to determine the densitometric relevance of minor design modifications of a cementless stem designed to improve proximal load transfer. We used a prospective cohort study with densitometric analysis over a five-year period of two groups of patients with primary osteoarthritis. The first group, 56 hips, received the first version of the ABG stem (ABG-I); the second group, 54 hips, had the ABG-II stem. The results obtained with the ABG-I stem showed a decrease of bone density in proximal areas that ranged from 13% to 37%. However, the new design had a decrease of the same areas that ranged from 9% to 23%. These differences were noted at the end of the first post-operative year and remained stable, except in zone 7, where they were progressive. There is little evidence that the modified stem reduces femoral bone density loss.Résumé Nous avons revu de façon rétrospective 68 hanches chez 62 patients présentant une dysplasie acétabulaire et ayant bénéficié d'une ostéotomie péri-acétabulaire. Parmi ces 68 hanches, 33 avaient en préopératoire une rétroversion acétabulaire (groupe rétroversion) et 35 une antéversion (groupe contrôle). Toutes les hanches ont été évaluées selon le score de Harris. L'évaluation radiographique de la rétroversion acétabulaire et du mur postérieur déficient ont été basées sur le signe du croisement et le signe du mur extérieur. Les scores cliniques des deux groupes au suivi final était semblable. Dans le groupe rétroversion, 12 hanches avaient antéversé leur acétabulum en post-opéra-toire le signe du mur postérieur disparaissant, mais celui-ci restant présent dans 21 hanches avec un acétabulum en rétroversion post-opératoire. Parmi les 21 hanches avec acétabulum rétroversé une coxarthrose postérieure s'est développée à 5 ans post-opératoire. Lorsque l'on réalise une correction par ostéotomie pour une hanche dysplasique avec un acétabulum rétroversé, il est important de corriger cette rétroversion de façon à prévenir une coxarthrose secondaire due à la déficience du mur postérieur.

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Determination of periprosthetic bone density with the DEXA method after implantation of custom-made uncemented femoral stems

Cited by 37 publications

References 9 publications

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

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

A computed tomography assessment of femoral and acetabular bone changes after total hip arthroplasty

Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem

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