Top

International Orthopaedics

Published in:

01-09-2018 | Review Article

Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review

Authors: Shuang G. Yan, Patrick Weber, Arnd Steinbrück, Xingyi Hua, Volkmar Jansson, Florian Schmidutz

Published in: International Orthopaedics | Issue 9/2018

Abstract

Purpose

Short-stem hip arthroplasty (SHA) was designed to preserve bone stock and provide an improved load transfer. To gain more evidence regarding the load transfer, this review analysed the periprosthetic bone remodelling of SHA in comparison to standard hip arthroplasty (THA).

Methods

PubMed and ScienceDirect were screened to extract dual-energy X-ray absorptiometry (DXA) studies evaluating the periprosthetic bone remodelling of SHA and two proven THA designs. From the studies included, the postoperative change in periprosthetic bone mineral density (BMD) after one year and the trend over two years was determined.

Results

Fifteen studies with four SHAs (CFP, Metha, Nanos, Fitmore) and two THAs (CLS and Bicontact) designs were included. All SHA and THA stems revealed an initial decrease at the calcar and major trochanter (Gruen 1 and 7) with the Metha, Nanos and Fitmore showing a smaller and more balanced remodelling compared to THA. The pattern after one year and the trend over two years argue for a methaphyseal anchorage of the Metha and Nanos, whereas the Fitmore and CFP seem to anchor metha-diaphyseal. Clearly different pattern of bone remodelling were observed between all four SHAs.

Conclusions

Periprosthetic bone remodelling is also present in SHA, with the main bone reduction observed proximally. However, certain SHA stems show a more balanced remodelling compared to THA, arguing for a favourable load transfer. Also, the femoral length where bone remodelling occurs is clearly shorter in SHA. As distinctively different pattern between the SHA designs were observed, they should not be judged as a single implant group.

Sumner DR (2015) Long-term implant fixation and stress-shielding in total hip replacement. J Biomech 48(5):797–800. https://doi.org/10.1016/j.jbiomech.2014.12.021 CrossRefPubMed

Kobayashi S, Saito N, Horiuchi H, Iorio R, Takaoka K (2000) Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Lancet 355(9214):1499–1504. https://doi.org/10.1016/S0140-6736(00)02164-4 CrossRefPubMed

Decking R, Rokahr C, Zurstegge M, Simon U, Decking J (2008) Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis. BMC Musculoskelet Disord 9:17. https://doi.org/10.1186/1471-2474-9-17 CrossRefPubMedPubMedCentral

Lerch M, von der Haar-Tran A, Windhagen H, Behrens BA, Wefstaedt P, Stukenborg-Colsman CM (2012) Bone remodelling around the metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop 36(3):533–538. https://doi.org/10.1007/s00264-011-1361-0 CrossRefPubMed

Schmidutz F, Graf T, Mazoochian F, Fottner A, Bauer-Melnyk A, Jansson V (2012) Migration analysis of a metaphyseal anchored short-stem hip prosthesis. Acta Orthop 83(4):360–365. https://doi.org/10.3109/17453674.2012.712891 CrossRefPubMedPubMedCentral

Freitag T, Hein MA, Wernerus D, Reichel H, Bieger R (2016) Bone remodelling after femoral short stem implantation in total hip arthroplasty: 1-year results from a randomized DEXA study. Arch Orthop Trauma Surg 136(1):125–130. https://doi.org/10.1007/s00402-015-2370-z CrossRefPubMed

Kutzner KP, Pfeil D, Kovacevic MP, Rehbein P, Mai S, Siebert W, Pfeil J (2016) Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases. Hip Int 26(3):278–283. https://doi.org/10.5301/hipint.5000339 CrossRefPubMed

Wittenberg RH, Steffen R, Windhagen H, Bucking P, Wilcke A (2013) Five-year results of a cementless short-hip-stem prosthesis. Orthop Rev (Pavia) 5(1):e4. https://doi.org/10.4081/or.2013.e4 CrossRef

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(2):115–121. https://doi.org/10.1007/s00223-002-2036-z CrossRefPubMed

10.

Salemyr M, Muren O, Ahl T, Boden H, Eisler T, Stark A, Skoldenberg O (2015) Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthop 86(6):659–666. https://doi.org/10.3109/17453674.2015.1067087 CrossRefPubMedPubMedCentral

11.

Albanese CV, Rendine M, De Palma F, Impagliazzo A, Falez F, Postacchini F, Villani C, Passariello R, Santori FS (2006) Bone remodelling in THA: a comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report. Hip Int 16(Suppl 3):9–15CrossRefPubMed

12.

Gasbarra E, Celi M, Perrone FL, Iundusi R, Di Primio L, Guglielmi G, Tarantino U (2014) Osseointegration of Fitmore stem in total hip arthroplasty. J Clin Densitom 17(2):307–313. https://doi.org/10.1016/j.jocd.2013.11.001 CrossRefPubMed

13.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269 W264CrossRefPubMed

14.

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 141:17–27

15.

Brinkmann V, Radetzki F, Delank KS, Wohlrab D, Zeh A (2015) A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses. J Orthop Traumatol 16(3):237–243. https://doi.org/10.1007/s10195-015-0335-1 CrossRefPubMedPubMedCentral

16.

Synder M, Krajewski K, Sibinski M, Drobniewski M (2015) Periprosthetic bone remodeling around short stem.Orthopedics. 38(3 Suppl):S40-S45

17.

Jahnke A, Engl S, Seeger JB, Basad E, Rickert M, Ishaque BA (2015) Influences of fit and fill following hip arthroplasty using a cementless short-stem prosthesis. Arch Orthop Trauma Surg 135(11):1609-1614

18.

Parchi PD, Ciapini G, Castellini I, Mannucci C, Nucci AM, Piolanti N, Maffei S, Lisanti M (2017) Evaluation of the effects of the Metha® short stem on periprosthetic bone remodelling in total hip arthroplasties: results at 48 months. Surg Technol Int 30:346-351

19.

Zeh A, Pankow F, Röllinhoff M, Delank S, Wohlrab D (2013) A prospective dual-energy X-ray absorptiometry study of bone remodeling after implantation of the Nanos short-stemmed prosthesis. Acta Orthop Belg 79(2):174-180

20.

Lazarinis S, Mattsson P, Milbrink J, Mallmin H, Hailer NP (2013)A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthop 84(1):32-39

21.

Wolf O, Mattsson P, Milbrink J, Larsson S, Mallmin H (2010) Periprosthetic bone mineral density and fixation of the uncemented CLS stem related to different weight bearing regimes: a randomized study using DXA and RSA in 38 patients followed for 5 years. Acta Orthop 81(3):286–291. https://doi.org/10.3109/17453674.2010.487238 CrossRefPubMedPubMedCentral

22.

Reiter A, Sabo D, Simank HG, Büchner T, Seidel M, Lukoschek M (1997) [Periprosthetic mineral density in cement-free hip replacement arthroplasty]. Z Orthop Ihre Grenzgeb 135(6):499-504

23.

Lerch M, Kurtz A, Windhagen H, Bouguecha A, Behrens BA, Wefstaedt P, Stukenborg-Colsman CM (2012) The cementless Bicontact stem in a prospective dual-energy X-ray absorptiometry study. Int Orthop 36(11):2211-2217

24.

Stukenborg-Colsman CM, von der Haar-Tran A, Windhagen H, Bouguecha A, Wefstaedt P, Lerch M (2012) Bone remodelling around a cementless straight THA stem: a prospective dual-energy X-ray absorptiometry study. Hip Int 22(2):166–171. https://doi.org/10.5301/hip.2012.9227 CrossRefPubMed

25.

von Lewinski G, Floerkemeier T (2015) 10-year experience with short stem total hip arthroplasty. Orthopedics 38(3 Suppl):S51–S56. https://doi.org/10.3928/01477447-20150215-57 CrossRef

26.

Schnurr C, Schellen B, Dargel J, Beckmann J, Eysel P, Steffen R (2017) Low short-stem revision rates: 1-11 year results from 1888 total hip arthroplasties. J Arthroplast 32(2):487–493. https://doi.org/10.1016/j.arth.2016.08.009 CrossRef

27.

Budde S, Seehaus F, Schwarze M, Hurschler C, Floerkemeier T, Windhagen H, Noll Y, Ettinger M, Thorey F (2016) Analysis of migration of the Nanos(R) short-stem hip implant within two years after surgery. Int Orthop 40(8):1607–1614. https://doi.org/10.1007/s00264-015-2999-9 CrossRefPubMed

28.

Speirs AD, Heller MO, Taylor WR, Duda GN, Perka C (2007) Influence of changes in stem positioning on femoral loading after THR using a short-stemmed hip implant. Clin Biomech (Bristol, Avon) 22(4):431–439. https://doi.org/10.1016/j.clinbiomech.2006.12.003 CrossRef

29.

Maier MW, Streit MR, Innmann MM, Kruger M, Nadorf J, Kretzer JP, Ewerbeck V, Gotterbarm T (2015) Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up. BMC Musculoskelet Disord 16:371. https://doi.org/10.1186/s12891-015-0830-9 CrossRefPubMedPubMedCentral

30.

Formica M, Cavagnaro L, Basso M, Zanirato A, Palermo A, Felli L (2017) What is the fate of the neck after a collum femoris preserving prosthesis? A nineteen years single center experience. Int Orthop 41(7):1329–1335. https://doi.org/10.1007/s00264-016-3350-9 CrossRefPubMed

31.

Schmidt R, Gollwitzer S, Nowak TE, Nowak M, Haberle L, Kress A, Forst R, Muller LA (2011) Periprosthetic femoral bone reaction after total hip arthroplasty with preservation of the collum femoris: CT-assisted osteodensitometry 1 and 3 years postoperatively. Orthopade 40(7):591–598. https://doi.org/10.1007/s00132-011-1745-2 CrossRefPubMed

32.

Briem D, Schneider M, Bogner N, Botha N, Gebauer M, Gehrke T, Schwantes B (2011) Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop 35(5):655–660. https://doi.org/10.1007/s00264-010-1020-x CrossRefPubMed

33.

Kress AM, Schmidt R, Nowak TE, Nowak M, Haeberle L, Forst R, Mueller LA (2012) Stress-related femoral cortical and cancellous bone density loss after collum femoris preserving uncemented total hip arthroplasty: a prospective 7-year follow-up with quantitative computed tomography. Arch Orthop Trauma Surg 132(8):1111–1119. https://doi.org/10.1007/s00402-012-1537-0 CrossRefPubMed

34.

Falez F, Casella F, Papalia M (2015) Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics 38(3 Suppl):S6–S13. https://doi.org/10.3928/01477447-20150215-50 CrossRefPubMed

35.

Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA (2014) Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 96(20):1742–1752. https://doi.org/10.2106/JBJS.M.00780 CrossRefPubMed

36.

Schmidutz F, Woiczinski M, Kistler M, Schroder C, Jansson V, Fottner A (2017) Influence of different sizes of composite femora on the biomechanical behavior of cementless hip prosthesis. Clin Biomech (Bristol, Avon) 41:60–65. https://doi.org/10.1016/j.clinbiomech.2016.12.003 CrossRef

37.

Aldinger PR, Thomsen M, Mau H, Ewerbeck V, Breusch SJ (2003) Cementless Spotorno tapered titanium stems: excellent 10-15-year survival in 141 young patients. Acta Orthop Scand 74(3):253–258. https://doi.org/10.1080/00016470310014157 CrossRefPubMed

38.

Gronewold J, Berner S, Olender G, Hurschler C, Windhagen H, von Lewinski G, Floerkemeier T (2014) Changes in strain patterns after implantation of a short stem with metaphyseal anchorage compared to a standard stem: an experimental study in synthetic bone. Orthop Rev (Pavia) 6(1):5211. https://doi.org/10.4081/or.2014.5211 CrossRef

39.

Merle C, Streit MR, Volz C, Pritsch M, Gotterbarm T, Aldinger PR (2011) Bone remodeling around stable uncemented titanium stems during the second decade after total hip arthroplasty: a DXA study at 12 and 17 years. Osteoporos Int 22(11):2879–2886. https://doi.org/10.1007/s00198-010-1483-z CrossRefPubMed

40.

Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, Kainberger F, Gottsauner-Wolf F (2004) Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. A five-year longitudinal study. J Bone Joint Surg Br 86(1):20–26CrossRefPubMed

41.

Ercan A, Sokkar SM, Schmid G, Filler TJ, Abdelkafy A, Jerosch J (2016) Periprosthetic bone density changes after MiniHipTM cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study. SICOT J 2:40. https://doi.org/10.1051/sicotj/2016033 CrossRefPubMedPubMedCentral

Title: Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review
Authors: Shuang G. Yan
Patrick Weber
Arnd Steinbrück
Xingyi Hua
Volkmar Jansson
Florian Schmidutz
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3691-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2018

Location of the femoral tunnel aperture during single-bundle posterior cruciate ligament reconstruction: outside-in versus inside-out techniques

Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes

A novel method of using elastic bionic fixation device for distal tibiofibular syndesmosis injury

Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion

Correction to: Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study

Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty—a multicentric analysis