The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty

Karachalios, Theofilos; Tsatsaronis, Christos; Efraimis, G.; Papadelis, P.; Lyritis, George P.; Diakoumopoulos, G.

doi:10.1016/j.arth.2003.12.081

Cited by 148 publications

(104 citation statements)

References 30 publications

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“…The bone loss that we found for the Elite Plus was similar to what Cohen found for the Charnley prosthesis after 1 year [l 11. Some studies following patients up to 10 years have shown a progressive recovery or a minimal loss of BMD after the first to second postoperative year [ 16,20,30,34]. A different pattern of BMD changes has been found around loosened implants [9,23,31,32].…”

Section: Bone-mineral Densitymentioning

confidence: 99%

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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The custom made Unique® stem is designed to fit closely to the metaphyseal region of the femur in order to obtain maximum mechanical stability and optimal load transfer. Thirty‐seven patients (38 hips) with non‐inflammatory arthritis were randomized to the uncemented custom made Unique® stem or the Elite Plus stem inserted with cement. The patients have been followed clinically as well as with radiostereometry (RSA) and Dual‐energy X‐ray Absorptiometry (DXA) for 2 years. After 2 years the RSA result showed minimal translation and rotation for the Unique® stem while the Elite Plus rotated slightly (mean 1.05°) into retroversion. Compared to previous studies the Elite Plus was as stable as the Charnley prosthesis. The DXA results showed a significantly higher proximal and total (10% for the Unique versus 5% for Elite) bone loss for the Unique® stem compared to the Elite Plus. Thus the optimal proximal press‐fit of the custom made stem did secure a stable fixation, but did not decrease the proximal bone loss. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Section: Bone-mineral Densitymentioning

confidence: 99%

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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“…The size of the sample was calculated by considering the average loss of BMD reported in previous studies in the seven zones of Gruen [6,8,10,18,20,21,23]. So, a minimum of 60 patients were considered necessary to be included in the study group.…”

Section: Methodsmentioning

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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“…This phenomenon is reportedly exacerbated with fully coated stems [12,15,18]. While stress shielding is seen radiographically, its clinical relevance remains to be determined [6,16,22]. Engh et al [16] have demonstrated, while stress shielding did occur in a cohort of the fully porous-coated stems they evaluated, this did not result in specific clinical complications.…”

Section: Introductionmentioning

confidence: 99%

Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial

MacDonald

Rosenzweig

Guerin

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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There are two broad-based categories of cementless femoral component designs: proximally porouscoated and fully porous-coated. While both have been widely used, there remains debate regarding differences in clinical outcome scores, relative incidence of thigh pain, and development of stress shielding. We investigated these variables in a multicenter prospective randomized blinded clinical trial of 388 patients from three centers: 198 patients had a proximally porous-coated tapered cementless femoral component and 190 patients had a fully porous-coated cementless femoral component. A minimum followup of 2 years (mean, 6.7 years; range, 2.0-8.65 years) was available in 367 of the 388 patients (95%).

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The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty

Cited by 148 publications

References 30 publications

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem

Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial

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