Early periprosthetic femoral bone remodelling using different bearing material combinations in total hip arthroplasties: a prospective randomised study

Abstract

The present study was performed to test the hypothesis that different bearing materials have an impact on femoral bone remodelling within the first year after a total hip arthroplasty. A total of 225 patients with osteoarthrosis of the hip or avascular necrosis of the femoral head were included in this randomised prospective study. All patients had an identical hybrid total hip arthroplasty (cemented BiMetric stem and cementless RingLoc acetabular cup) except for the bearing materials: polyethylene-on-zirconia (n = 78), CoCr-on-CoCr (n = 71), or alumina-on-alumina (n = 76). Bone mineral density (BMD) was measured with Dual-energy X-ray absorptiometry (DEXA) in seven Gruen zones adjacent to the femoral implant. The DEXA scan was performed within one week after surgery and was repeated one year postoperatively. There was no significant difference in periprosthetic BMD change between the three groups. After twelve months the relative BMD decrease was highest in the proximal part of the femur, -6.2% in the greater trochanter region and -12.7% in the lesser trochanter region. In the distal zones the relative BMD decrease was -5.3, -4.2, -2.1, -2.3, and -5.6%, respectively. The use of different bearing materials had no significant impact on femoral bone remodelling adjacent to the cemented hip stem within one year after surgery.

Quantitative Measurements of Adaptive Bone Remodeling Around the Cemented Zimmer® Segmental Stem After Tumor Resection Arthroplasty Using Dual-energy x-ray absorptiometry

“…We found a precision of BMD measurement of CV 2%-5% which is slightly higher compared to poorer precision, the smaller ROI size therefore could be an explanation. Nevertheless, we find our CV comparable to previous findings of cemented hip and knee arthroplasty which has proven to be adequate values to detect small adaptive bone remodeling changes (14,23,34).…”

“…During the first year after surgery, significant BMD changes were seen in all four ROI around the The pattern in bone remodeling along the Zimmer® Segmental stem is corresponding to other findings after both cemented and uncemented primary hip arthroplasty (11,21,23,24). Bone remodeling and bone resorption adjacent to the proximal part of the stem is caused by distal transfer load of the prostheses due to the greater stiffness of the stem.…”

“…It is well known from primary hip or knee arthroplasty that lesser stem stiffness, shorter stems and also coating may contribute to retain normal load transfer, and thus enhance bone preservation (12,24,30). The various long-term follow-up results in periprosthetic BMD shows that adaptive bone remodeling after surgery also may contribute to better fixation as opposed to loosening and that it could depend on fixation method of the prostheses due to advantageous distribution and transmission of load.…”

Continuous bone loss around a tapered uncemented femoral stem: A long-term evaluation with DEXA

“…The weakened bone may also cause complications in revison surgery. This phenomenon has been described most often with uncemented stems, but remodeling has also been observed around stable cemented stems (Cohen and Rushton 1995b, Venesmaa et al 2003, Nygaard et al 2004). …”

The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip Arthroplasty

“…However, the type of PE used in both cup types was the same. It is known from a previous study that difference in bearing materials did not affect BMD in the proximal femur in the short term perspective (231).…”