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Osteoporosis International

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01-11-2011 | Original Article

Bone remodeling around stable uncemented titanium stems during the second decade after total hip arthroplasty: a DXA study at 12 and 17 years

Authors: C. Merle, M. R. Streit, C. Volz, M. Pritsch, T. Gotterbarm, P. R. Aldinger

Published in: Osteoporosis International | Issue 11/2011

Abstract

Summary

In a cohort study, bone mineral density (BMD) around uncemented femoral components after total hip arthroplasty (THA) was evaluated. The results suggest that there are no clinically relevant changes in overall periprosthetic BMD in the second decade. However, continuous remodeling with limited proximal bone loss (stress-shielding) occurs, predominantly in female patients.

Introduction

Progressive periprosthetic bone loss and stress-shielding are a major concern in THA. Little is known about the extent and pattern of periprosthetic bone remodeling around uncemented stems in the second decade.

Methods

In a cohort study, periprosthetic BMD was measured in 131 patients with 146 uncemented CLS stems using dual-energy X-ray absorptiometry (DXA) at a mean of 12 years postoperatively (t1). Patients were followed clinically and radiographically, and a second DXA was performed at a mean of 17 years postoperatively (t2) using the identical protocol.

Results

We obtained a complete set of two consecutive DXA measurements for 88 hips (78 patients, 35 male, 43 female). On radiographic evaluation at t1 and t2, regular bone ongrowth was present in all cases and no signs of radiographic loosening, severe bone loss or diaphyseal cortical hypertrophy were detected. There was no clinically relevant change in overall periprosthetic BMD (netavg) between t1 and t2 for both male and female patients. We analyzed the differences in BMD in the periprosthetic regions of interest (ROIs) according to Gruen and found a slight decrease in periprosthetic BMD in ROI 7 in male patients and in ROIs 1, 4, 6 and 7 in female patients.

Conclusions

The study suggests that there are no clinically relevant changes in overall periprosthetic BMD around stable, straight uncemented stems between 12 and 17 years postoperatively. However, continuous remodeling with limited proximal bone loss occurs, predominantly in female patients. After secondary osteointegration of this implant, stress-shielding remains minimal in the second decade.

Aldinger PR, Jung AW, Breusch SJ, Ewerbeck V, Parsch D (2009) Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res 467:2297–2304PubMedCrossRef

Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI (2007) Medium- and long-term performance of 11.516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg Br 89:1574–1580PubMedCrossRef

Makela KT, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V (2008) Total hip arthroplasty for primary osteoarthritis in patients fifty-five years of age or older. An analysis of the Finnish arthroplasty registry. J Bone Joint Surg Am 90:2160–2170PubMedCrossRef

Wilkinson JM, Hamer AJ, Rogers A, Stockley I, Eastell R (2003) Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty. J Orthop Res 21:691–696PubMedCrossRef

Engh CA Jr, Young AM, Engh CA Sr, Hopper RH Jr (2003) Clinical consequences of stress shielding after porous-coated total hip arthroplasty. Clin Orthop Relat Res 157–163

Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654PubMedCrossRef

Aldinger PR, Sabo D, Pritsch M, Thomsen M, Mau H, Ewerbeck V, Breusch SJ (2003) Pattern of periprosthetic bone remodeling around stable uncemented tapered hip stems: a prospective 84-month follow-up study and a median 156-month cross-sectional study with DXA. Calcif Tissue Int 73:115–121PubMedCrossRef

Boden HS, Skoldenberg OG, Salemyr MO, Lundberg HJ, Adolphson PY (2006) Continuous bone loss around a tapered uncemented femoral stem: a long-term evaluation with DEXA. Acta Orthop 77:877–885PubMedCrossRef

Panisello JJ, Herrero L, Canales V, Herrera A, Martinez AA, Mateo J (2009) Long-term remodeling in proximal femur around a hydroxyapatite-coated anatomic stem: ten years densitometric follow-up. J Arthroplasty 24:56–64PubMedCrossRef

10.

Stiehl JB (2009) Long-term periprosthetic remodeling in THA shows structural preservation. Clin Orthop Relat Res 467:2356–2361PubMedCrossRef

11.

Spotorno L, Romagnoli S, Ivaldo N, Grappiolo G, Bibbiani E, Blaha DJ, Guen TA (1993) The CLS system. Theoretical concept and results. Acta Orthop Belg 59(Suppl 1):144–148PubMed

12.

Aldinger PR, Breusch SJ, Lukoschek M, Mau H, Ewerbeck V, Thomsen M (2003) A ten- to 15-year follow-up of the cementless spotorno stem. J Bone Joint Surg Br 85:209–214PubMedCrossRef

13.

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755PubMed

14.

Devane PA, Robinson EJ, Bourne RB, Rorabeck CH, Nayak NN, Horne JG (1997) Measurement of polyethylene wear in acetabular components inserted with and without cement. A randomized trial. J Bone Joint Surg Am 79:682–689PubMed

15.

Devane PA, Horne JG, Martin K, Coldham G, Krause B (1997) Three-dimensional polyethylene wear of a press-fit titanium prosthesis. Factors influencing generation of polyethylene debris. J Arthroplasty 12:256–266PubMedCrossRef

16.

Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 17–27

17.

Willert HG, Bertram H, Buchhorn GH (1990) Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res 95–107

18.

Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 69:45–55PubMed

19.

Kiratli BJ, Checovich MM, McBeath AA, Wilson MA, Heiner JP (1996) Measurement of bone mineral density by dual-energy X-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem. J Arthroplasty 11:184–193PubMedCrossRef

20.

Mortimer ES, Rosenthall L, Paterson I, Bobyn JD (1996) Effect of rotation on periprosthetic bone mineral measurements in a hip phantom. Clin Orthop Relat Res 269–274

21.

Ang KC, De Das S, Goh JC, Low SL, Bose K (1997) Periprosthetic bone remodelling after cementless total hip replacement. A prospective comparison of two different implant designs. J Bone Joint Surg Br 79:675–679PubMedCrossRef

22.

Kiratli BJ, Heiner JP, McBeath AA, Wilson MA (1992) Determination of bone mineral density by dual X-ray absorptiometry in patients with uncemented total hip arthroplasty. J Orthop Res 10:836–844PubMedCrossRef

23.

Trevisan C, Bigoni M, Randelli G, Marinoni EC, Peretti G, Ortolani S (1997) Periprosthetic bone density around fully hydroxyapatite coated femoral stem. Clin Orthop Relat Res 109–117

24.

Venesmaa PK, Kroger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM (2001) Monitoring of periprosthetic BMD after uncemented total hip arthroplasty with dual-energy X-ray absorptiometry—a 3-year follow-up study. J Bone Miner Res 16:1056–1061PubMedCrossRef

25.

Rahmy AI, Gosens T, Blake GM, Tonino A, Fogelman I (2004) Periprosthetic bone remodelling of two types of uncemented femoral implant with proximal hydroxyapatite coating: a 3-year follow-up study addressing the influence of prosthesis design and preoperative bone density on periprosthetic bone loss. Osteoporos Int 15:281–289PubMedCrossRef

26.

Gibbons CE, Davies AJ, Amis AA, Olearnik H, Parker BC, Scott JE (2001) Periprosthetic bone mineral density changes with femoral components of differing design philosophy. Int Orthop 25:89–92PubMedCrossRef

27.

Sychterz CJ, Engh CA (1996) The influence of clinical factors on periprosthetic bone remodeling. Clin Orthop Relat Res 285–292

28.

Kroger H, Venesmaa P, Jurvelin J, Miettinen H, Suomalainen O, Alhava E (1998) Bone density at the proximal femur after total hip arthroplasty. Clin Orthop Relat Res 66–74

29.

Nishii T, Sugano N, Masuhara K, Shibuya T, Ochi T, Tamura S (1997) Longitudinal evaluation of time related bone remodeling after cementless total hip arthroplasty. Clin Orthop Relat Res 121–131

30.

Kroger H, Miettinen H, Arnala I, Koski E, Rushton N, Suomalainen O (1996) Evaluation of periprosthetic bone using dual-energy X-ray absorptiometry: precision of the method and effect of operation on bone mineral density. J Bone Miner Res 11:1526–1530PubMedCrossRef

31.

Karachalios T, Tsatsaronis C, Efraimis G, Papadelis P, Lyritis G, Diakoumopoulos G (2004) The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty: a 10-year, prospective, randomized study. J Arthroplasty 19:469–475PubMedCrossRef

32.

Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, Kiel DP (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:710–720PubMedCrossRef

33.

Simank HG, Brocai DR, Reiser D, Thomsen M, Sabo D, Lukoschek M (1997) Middle-term results of threaded acetabular cups. High failure rates five years after surgery. J Bone Joint Surg Br 79:366–370PubMedCrossRef

34.

Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR (1995) Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum 38:907–916PubMedCrossRef

Title: Bone remodeling around stable uncemented titanium stems during the second decade after total hip arthroplasty: a DXA study at 12 and 17 years
Authors: C. Merle
M. R. Streit
C. Volz
M. Pritsch
T. Gotterbarm
P. R. Aldinger
Publication date: 01-11-2011
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 11/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1483-z

At a glance: The STEP trials

Springer Medicine

Bone remodeling around stable uncemented titanium stems during the second decade after total hip arthroplasty: a DXA study at 12 and 17 years

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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