Inter- and intraobserver assessment of periacetabular osteodensitometry after cemented and uncemented total hip arthroplasty using computed tomography

Schmidt, Rainer; Pitto, Rocco P.; Kreß, Alexander; Ehremann, Cornelia; Nowak, T.; Reulbach, Udo; Forst, Raimund; Müller, Lutz

doi:10.1007/s00402-005-0812-8

Cited by 29 publications

(21 citation statements)

References 22 publications

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“…[2][3][4][5][6][7]11,[15][16][17] To allow a differentiated three-dimensional analysis of cortical and cancellous bone structures after THA in vivo we have introduced a novel method of CT-assisted osteodensitometry. 9,10,13,14 In a previous study we have provided clear evidences for the reproducibility and validity of our method. 9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty.…”

mentioning

confidence: 60%

“…9,10,13,14 In a previous study we have provided clear evidences for the reproducibility and validity of our method. 9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty. 13,14 A DXA based study by Sabo et al 11 showed a decrease of periacetabular BD 24 months after implantation of a rigid press fit cup.…”

mentioning

confidence: 60%

“…High reproducibilty of the method has been described previously. 9 The standardized patient positioning and CT scanning technique allowed an exact evaluation of cortical and cancellous BD (relative change of periprosthetic BD as a function of time; initial postoperative BD value as the baseline value) of all patients.…”

Section: Bone Density Measurementsmentioning

confidence: 99%

“…1 In the last century increasing knowledge of load transfer mechanisms and stress distribution patterns after total hip replacements was provided. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of these studies have focussed on stress shielding mechanisms after femoral stem implantation. [2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique.…”

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confidence: 99%

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Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

Mueller

Schmidt

Ehrmann

et al. 2008

Journal Orthopaedic Research

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Stress-shielding and periprosthetic bone loss after total hip arthroplasty (THA) may be clinically relevant for high-demand patients. Analysis of cortical and cancellous bone density (BD) changes in vivo after THA is of interest to basic science researchers and joint reconstruction surgeons. An insufficient periprosthetic bone stock may predispose to migration, early mechanical failure, and major problems in revision surgery. We used computed tomography (CT)-assisted osteodensitometry in two prospectively analyzed cohorts after cemented (n ¼ 21) versus noncemented (n ¼ 23) cup fixation. Periacetabular BD (mgCaHa/mL) was determined in five CT scans cranial and five CT scans at the level of the cup 10 days and 26 months postoperatively. For press-fit cups BD decreased significantly in all CT cans except in four out of the five scans of cortical bone cranial to the cup. The decrease was highest for cancellous bone ventral to the cup (À45 to À53%). After cemented cup fixation, significant cortical BD decrease was seen ventral to the cup (À11 to À20%). Cancellous BD decrased only ventral (À21 to À31%) and in two scans cranial (À11 and À12%) to the cup. The modes of load transfer between cemented and uncemented cups differ fundamentally. Cemented cups especially prevent the loss of cancellous bone of the acetabulum while also cortical BD loss was significantly lower in most CT scans surrounding the cemented cup compared to the press-fit component. Long-term results are required to prove whether third-generation cementing technique protects periprosthetic BD and thereby improve implant survival. Keywords: osteodensitometry; computed tomography; total hip arthroplasty; acetabulum; load transfer Bone is a highly organized tissue that reacts to mechanical load in a typical stress related pattern according to Wolff's law. 1 In the last century increasing knowledge of load transfer mechanisms and stress distribution patterns after total hip replacements was provided. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of these studies have focussed on stress shielding mechanisms after femoral stem implantation. [2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique. [2][3][4][5][6][7]11,[15][16][17] To allow a differentiated three-dimensional analysis of cortical and cancellous bone structures after THA in vivo we have introduced a novel method of CT-assisted osteodensitometry. 9,10,13,14 In a previous study we have provided clear evidences for the reproducibility and validity of our method. 9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty. 13,14 A DXA based study by Sabo et al. 11 showed a decrease of periacetabular BD 24 months after implantation of a rigid press fit cup. T...

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mentioning

confidence: 60%

mentioning

confidence: 60%

Section: Bone Density Measurementsmentioning

confidence: 99%

mentioning

confidence: 99%

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Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

Mueller

Schmidt

Ehrmann

et al. 2008

Journal Orthopaedic Research

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“…Using sectional CT imaging, a separate analysis of cortical and cancellous bone structures can be achieved [17,18]. The CT-assisted osteodensitometry technology used in this study is accurate and reproducible [16,19]. We found BD loss ranging from −17% to −0.9% in the cortical bone and ranging from −22% to −4% in the cancellous bone.…”

Section: Discussionmentioning

confidence: 91%

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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Chronic Pelvic Discontinuity

Gebrelul,

Pirruccio,

Velasco

et al. 2023

Hip Arthroplasty

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Inter- and intraobserver assessment of periacetabular osteodensitometry after cemented and uncemented total hip arthroplasty using computed tomography

Cited by 29 publications

References 22 publications

Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

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

Chronic Pelvic Discontinuity

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