Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Teusink, Matthew J.; Callaghan, Katharine A.; Klocke, Noelle; Goetz, Devon D.; Callaghan, John J.

doi:10.1007/s11999-013-2873-2

Cited by 13 publications

(4 citation statements)

References 21 publications

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“…These outcomes agree with those from our study. However, Teusink et al evaluated radiographs from 106 cemented THAs in patients who had a mean age of 53 years (range: 23–70 years). At a mean follow‐up of 25 years (range: 20–37 years), early remodeling was characterized by distal cortical hypertrophy, whereas late remodeling involved cortical thinning.…”

Section: Discussionmentioning

confidence: 99%

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

et al. 2014

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ABSTRACT:We determined the effect of pre-operative bone structure upon the temporal effects of remodeling after total hip arthroplasty (THA) in a series of uncemented implants. We evaluated 345 patients (375 hips), who had either Dorr Type-A (238 hips) or Type-B (137 hips) bone, and who received a proximally-coated cementless THA and were followed for a mean of 6 years. Outcomes evaluated included aseptic survivorship, Harris hip scores, and radiographic evaluation for patterns of remodeling. The aseptic survivorship (97.5% vs. 98%) and the mean final Harris hip scores (92 vs. 94 points) were similar between Types-A and -B bone, respectively. Bone remodeling was seen significantly earlier and over a longer duration for patients who had Type-B bone. At 5-years, periprosthetic condensation (78% vs. 54%) and cortical hypertrophy (53% vs. 37%) were significantly higher and radiolucencies at any zone were lower (53% vs. 37%) in Type-B compared to Type-A bone. There was increased condensation in men and higher cortical hypertrophy in women. Various radiographic remodeling differences may not negatively impact clinical outcome at mid-term follow-up.Morphologic bone type appears to be predictive of physiologic response to loading. ß

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Section: Discussionmentioning

confidence: 99%

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

et al. 2014

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“…Cortical hypertrophy (CH) is one of several observed bone remodeling mechanisms after total hip arthroplasty (THA). It is a thickening of cortical bone in an adaptive response to altered external mechanical loads, which can cause internal stress and proximal cortical thinning in the femur [1, 2]. Initially, CH was observed around cemented stems [2].…”

Section: Introductionmentioning

confidence: 99%

“…It is a thickening of cortical bone in an adaptive response to altered external mechanical loads, which can cause internal stress and proximal cortical thinning in the femur [1, 2]. Initially, CH was observed around cemented stems [2]. The intensified appearance around uncemented stems is explained by stress-shielding, a reactive proximal bone atrophy combined with distal bone hypertrophy caused by aberrant loading through distal site [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

et al. 2019

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Background An increased occurrence of cortical hypertrophy (CH) was observed 1–2 years after implanting short curved Fitmore hip stems. There are no published data about either the clinical relevance or the progression of CH over the long term. Methods Ninety-six primary total hip arthroplasties were performed between 2008 and 2010 using the Fitmore hip stem. Clinical and radiological parameters were recorded preoperatively and at 1, 2, 3, and 5 year follow-up. Results CH appeared mainly on antero-posterior radiographs in Gruen Zones 2, 3, 5, and 6. After 1 year, the diameter was 10 ± 2 mm and remained constant thereafter. The CH rate after 1 year was 69% and after 5 years 71%. Subsidence after 1 year was 1.6 ± 1.55 mm and 1.93 ± 1.72 mm after 5 years. Cortical thinning was 46% after 1 year and 56% after 5 years, mainly in Gruen Zones 7 and 8. In the first year radiolucencies were found in 51% in all Gruen Zones, and in 20% after 5 years. Patient, implant, and surgical factors did not correlate with radiological outcomes except that larger stems had more CH. After 5 years, the Harris Hip Score had improved from 59 to 94 and the Oxford Hip Score from 22 to 41. Radiographic parameters, notably CH, were not associated with clinical outcomes except that cortical thinning correlated with lower outcome scores. Conclusions CH correlated neither with clinical outcome nor with patient, surgical or implant factors, except for a positive correlation with stem size. The Fitmore hip stems settled within the first year to a stable fixation and then remained almost unchanged. However, cortical thinning is common in Gruen Zone 7 and 8 meaning that there is stress-shielding.

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“…Although the increased risk of revision in younger patients has been almost entirely attributed to higher activity levels and higher loading on the joints, it is unknown whether other age-related factors that affect bone quality and in turn contribute to the excess risk of revisions in young patients. We believe further studies are warranted to better understand the age effect, such as studies of periprosthetic bone remodeling 16 , in vivo and in vitro studies of the potential role of bone mineral density, bone mineral content, peak bone mass and bone turnover markers on osseointegration and risk of aseptic loosening in THA and TKA. Because tissue regeneration around implants depends on endogenous mesenchymal stem cells, it will be informative to assess whether the molecular properties of stem cells and their ability to support peri-implant bone formation is altered.…”

Section: Demographic Factorsmentioning

confidence: 99%

Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants

et al. 2016

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Total hip and knee arthroplasty are effective interventions for management of end-stage arthritis. Indeed, about 7 million Americans are currently living with artificial hip and knee joints. The majority of these individuals, however, will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration and aseptic loosening. Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In this review, we summarize the published clinical literature on the role of demographics, biologic factors, comorbidities, medications and aseptic loosening risk. We focus on several systemic and local factors that are particularly relevant to implant osseointegration. Examples include physiological and molecular processes that are linked to hyperglycemia, oxidative stress, metabolic syndrome and dyslipidemia. We discuss how orthopedic implant osseointegration can be affected by a number of molecular therapies that are antiresorptive or bone anabolic (i.e. calcium, vitamin D, bisphosphonates, calcitonin, strontium, hormone replacement therapy, selective estrogen-receptor modulators).

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Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Cited by 13 publications

References 21 publications

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants

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