Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems

Albanese, Carlina V.; Santori, F. S.; Pavan, Laura; Learmonth, Ian D.; Passariello, Roberto

doi:10.3109/17453670903074467

Cited by 75 publications

(72 citation statements)

References 39 publications

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“…4). Although long-term results of short stems are unclear, it can be assumed that a concentrated load distribution on the medial portion of the femur might be an important factor for long-term implant survival in short-stemmed THA [5,21,33,34]. This has not yet been reported for conventional proximal porous-coated straight stems and might suggest a relatively physiological load bearing.…”

Section: Discussionmentioning

confidence: 87%

The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study

Lerch

Kurtz

Bouguecha

et al. 2012

International Orthopaedics (SICOT)

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Purpose The cementless Bicontact® total hip arthroplasty (THA) system (AESCULAP AG, Tuttlingen, Germany) was introduced in 1986/1987 and has been in successful clinical use in an unaltered form up to today. Although good longterm results with the Bicontact® stem have been published, it is questionable whether the implant provides the criteria for a state-of-the-art stem regarding proximal bone stock preservation. The purpose of the study was to monitor the periprosthetic bone mineral density (BMD) in a prospective two-year follow-up dual-energy X-ray absorptiometry (DEXA) study. Methods After power analysis, a consecutive series of 25 patients with unilateral Bicontact® stem implantation was examined clinically and underwent DEXA examinations. Scans of seven regions of interest were taken preoperatively and at one week, six months, and one and two years. Results One patient required stem revision due to a deep infection. The Harris Hip Score increased significantly by 44 points. The most significant bone loss was observed in the calcar region (R7) in the first six months (−19.2 %). It recovered in the following 18 months to −8.5 %. The BMD in the greater trochanter dropped significantly after six months and remained stable at this level. BMD exceeded baseline values in distal regions and even more in the lesser trochanter region after two years. Conclusions We conclude that the Bicontact® stem provides adequate proximal bone stock preservation. We observed some signs of stress shielding at the tip of the stem, which is inevitable to some degree in THA with cementless straight stems. However, in this prospective DEXA investigation, we showed that proximal off-loading does not occur after THA with the Bicontact® system. Thus, we believe that this stem is still a state-of-the-art implant.

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Section: Discussionmentioning

confidence: 87%

The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study

Lerch

Kurtz

Bouguecha

et al. 2012

International Orthopaedics (SICOT)

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“…Excellent clinical and radiographic mid-term results have been reported, but most of the short stems have not been able to reduce BMD loss in the proximal femoral regions (Albanese et al 2009, Chen et al 2009, Gotze et al 2010, Lerch et al 2012, Lazarinis et al 2013). …”

Section: Discussionmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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“…DEXA studies investigating the influence of femoral stem length have shown that progressive shortening of the stem produces more proximal loading, which preserves metaphyseal bone stock and increases bone mineral density (BMD) in the medial zones [2].…”

Section: Bone Conservationmentioning

confidence: 99%

“…In particular, it seeks to address the following questions: (1) What are the advantages of preserving the femoral neck during THA? (2) What are the clinical and radiological outcomes of femoral neck-preserving implants?…”

Section: Introductionmentioning

confidence: 99%

Neck-Preserving Femoral Stems

Rajakulendran

Field

2012

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages. Purposes: The objectives of this study were to review:(1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems. Methods: A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct. Results: Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known. Conclusions: Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate on-going bone remodelling and assess implant performance and survival.

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Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems

Cited by 75 publications

References 39 publications

The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study

The cementless Bicontact® stem in a prospective dual-energy X-ray absorptiometry study

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Neck-Preserving Femoral Stems

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