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Periprothetische femorale Knochenreaktion nach schenkelhalserhaltender Hüftendoprothetik

CT-gestützte Osteodensitometrie 1 und 3 Jahre postoperativ

Periprosthetic femoral bone reaction after total hip arthroplasty with preservation of the collum femoris

CT-assisted osteodensitometry 1 and 3 years postoperatively

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Zusammenfassung

Hintergrund

Das Ziel der Implantation kurzschaftiger Hüftendoprothesen ist eine metaphysäre Kraftübertragung und somit der Erhalt des proximalen femoralen Knochens. Mittels CT-gestützter Osteodensitometrie kann die periprothetische kortikale und spongiöse Knochendichte (KD) nach Implantation zementfreier Hüftendoprothesen in vivo bestimmt werden.

Patienten und Methoden

In einer prospektiven Studie wurden bei 31 Patienten (31 Hüften) neben den üblichen klinischen (Harris Hip Score) und nativradiologischen Untersuchungen die femorale kortikale und spongiöse KD (mg CaHA/ml) einer schenkelhalserhaltenden Prothese (C.F.P.-Schaft, Fa. Link, Hamburg) mittels CT-gestützter Osteodensitometrie 10 Tage, 1 und 3 Jahre postoperativ bestimmt.

Ergebnisse

Der proximale kortikale KD-Verlust war zwischen der Ein- (Ø −8%) und 3-Jahres-Kontrolle (Ø −22%) progredient. Distal des Trochanter minor wurden keine signifikanten kortikalen KD-Veränderungen beobachtet. Die proximale spongiöse KD-Abnahme war ebenfalls zwischen der Ein- (Ø −33%) und 3-Jahres-Kontrolle (Ø −45%) Kontrolle progredient. Der Harris Hip Score verbesserte sich von 45 Punkten präoperativ auf 93 Punkte 3 Jahre postoperativ. Nativradiologisch waren alle Prothesen ohne Nachweis von Säumen oder Osteolysen knöchern fest integriert.

Schlussfolgerung

Die periprothetische CT-gestützte Osteodensitometrie bietet die technischen Voraussetzungen, um in vivo zwischen kortikalen und spongiösen KD-Veränderungen zu differenzieren. Der progrediente proximale kortikale und spongiöse KD-Verlust zeigt, dass eine metaphysäre Kraftübertragung mit dem analysierten C.F.P.-Schaft nicht erreicht werden kann. Der fehlende kortikale KD-Verlust unterhalb des Trochanter minor deutet auf eine diaphysäre Verankerung der Prothese hin.

Abstract

Background

Short-stemmed cementless femoral components in total hip arthroplasty have been designed to preserve the proximal femoral bone stock by load transfer to the femoral metaphysis. An in vivo method of computed tomography-assisted (CT) osteodensitometry after total hip arthroplasty is presented which differentiates between cortical and cancellous bone density (BD) changes around uncemented femoral components.

Patients and methods

Cortical and cancellous periprosthetic femoral BD (mg Ca HA/ml) was determined prospectively in 31 patients at day 10, 1 year and 3 years after total hip arthroplasty with preservation of the collum femoris (C.F.P.-stem, Link, Hamburg, Germany) using computed tomography-assisted osteodensitometry. Clinical results (Harris hip score) and plain x-rays were assessed in all cases.

Results

Progressive proximal cortical BD loss was observed between the 1 year (Ø −8%) and 3 year (Ø −22%) postoperative measurements. Distal to the trochanter minor no significant cortical BD changes were observed. Proximal cancellous BD decreased progressively between the 1 year (Ø −33%) and 3 year (Ø −45%) analyses. The Harris hip score improved from 45 points pre-operatively to 93 points at the 3 year follow-up. All x-rays showed signs of stable ingrowth.

Conclusion

Periprosthetic CT osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling. Progressive proximal cortical and cancellous BD loss indicates that metaphyseal fixation cannot be achieved with the analyzed C.F.P. stem design. The lack of cortical BD loss below the trochanter minor suggests diaphyseal fixation of the implanted stem.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Studie wurde von der Firma Waldemar Link GmbH & Co. KG finanziert.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik im Waldkrankenhaus St. Marien gGmbH, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, 91054, Erlangen, Deutschland

    R. Schmidt, S. Gollwitzer, A. Kress, R. Forst & L.A. Müller

  2. Klinik und Poliklinik für Unfallchirurgie, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    T.E. Nowak & M. Nowak

  3. Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    L. Häberle

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  1. R. Schmidt
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  2. S. Gollwitzer
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  3. T.E. Nowak
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  4. M. Nowak
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  5. L. Häberle
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  6. A. Kress
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  7. R. Forst
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  8. L.A. Müller
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Correspondence to L.A. Müller.

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Schmidt, R., Gollwitzer, S., Nowak, T. et al. Periprothetische femorale Knochenreaktion nach schenkelhalserhaltender Hüftendoprothetik. Orthopäde 40, 591–599 (2011). https://doi.org/10.1007/s00132-011-1745-2

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