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BMC Musculoskeletal Disorders

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Open Access 01-12-2021 | Research

Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry

Authors: Christina Enciso Holm, Peter Horstmann, Michala Skovlund Sørensen, Karen Dyreborg, Michael Mørk Petersen

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

Limb salvage surgery (LSS) is the preferred method for treatment of patients with sarcomas and to a greater extent also to patients with metastatic bone disease. The aim of the present study was to evaluate the adaptive remodeling of the periprosthetic cortical bone after insertion of a tumor prosthesis with cemented stem.

Methods

A prospective study of 21 patients (F/M = 12/9), mean age 55 years (range 15–81) with metastatic bone disease (n = 9), sarcomas (n = 8) or aggressive benign tumors (n = 4) who underwent bone resection due to a tumor, and reconstruction with a tumor-prosthesis (Zimmer® Segmental 130 mm straight fluted cemented stem with trabecular metal (TM) collars) in the proximal femur (n = 10), distal femur (n = 9) or proximal tibia (n = 2). Measurements of bone mineral density (BMD) (g/cm²) were done postoperatively and after 3, 6, and 12 months using dual-energy X-ray absorptiometry. BMD was measured in 4 regions of interest around the cemented stem and in one region of interest 1 cm proximal from the ankle joint of the affected limb and measurement of the contralateral ankle was used as reference. Repeated measures ANOVA and students paired t-test was used to evaluate BMD changes over time.

Results

At 1-year follow-up, BMD decreased compared to baseline in all four regions of interest with a statistically significant bone loss of 8–15%. The bone loss was most pronounced (14–15%) in the 2 regions of interest closest to the trabecular metal (TM) collar and lowest (8%) adjacent to the tip of the stem.

Conclusion

After 1 year the decrease in bone mineral density of the ankle on the affected limb was 9% and the contralateral ankle was close to baseline, thus suggesting that the periprosthetic bone mineral density changes during follow-up, mainly are caused by stress shielding and immobilization.

Trial registration

The study was approved by the Scientific Ethical Committee of the Capital Region of Denmark (J. No. H-2-2014-105) and the Danish Data Protection Agency (J. No.:2012–58-00004).

Hwang JS, Mehta AD, Yoon RS, Beebe KS. From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology. J Orthop Traumatol. 2014;15(2):81–6. https://doi.org/10.1007/s10195-013-0265-8.CrossRefPubMed

Grimer RJ, Taminiau AM, Cannon SR. Surgical outcomes in osteosarcoma. J Bone Jt Surg - Br Vol. 2002;84(3):395–400. https://doi.org/10.1302/0301-620X.84B3.0840395.CrossRef

Sørensen MS, Gregersen KG, Grum-Schwensen T, Hovgaard D, Petersen MM. Patient and implant survival following joint replacement because of metastatic bone disease. Acta Orthop. 2013;84:301.CrossRef

Holzer G, Krepler P, Koschat MA, Grampp S, Dominkus M, Kotz R. Bone mineral density in long-term survivors of highly malignant osteosarcoma. J Bone Jt Surg - Br Vol. 2003;85(2):231–7.CrossRef

Davis AM, Damani M, White LM, Wunder JS, Griffin AM, Bell RS. Periprosthetic bone remodeling around a prosthesis for distal femoral tumors: longitudinal follow-up. J Arthroplast. 2005;20(2):219–24. https://doi.org/10.1016/j.arth.2004.10.009.CrossRef

Jarvinen M, Kannus P. Current concepts review-injury of an extremity as a risk factor for the development of osteoporosis. J Bone Jt Surg Am. 1997;79(2):263–76. https://doi.org/10.2106/00004623-199702000-00017.CrossRef

Kerner J, Huiskes R, Van Lenthe GH, Weinans H, Van Rietbergen B, Engh CA, et al. Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling. J Biomech. 1999;32(7):695–703. https://doi.org/10.1016/S0021-9290(99)00041-X.CrossRefPubMed

Lan F, Wunder JS, Griffin AM, Davis AM, Bell RS, White LM, et al. Periprosthetic bone remodelling around a prosthesis for distal femoral tumours. J Bone Jt Surg - Br Vol. 2000;82-B(1):120–5. https://doi.org/10.1302/0301-620X.82B1.0820120.CrossRef

Abu-Rajab RB, Watson WS, Walker B, Roberts J, Gallacher SJ, Meek RMD. Peri-prosthetic bone mineral density after total knee arthroplasty. J Bone Jt Surg - Br Vol. 2006;88(5):606–13.CrossRef

10.

Pala E, Trovarelli G, Angelini A, Maraldi M, Berizzi A, Ruggieri P. Megaprosthesis of the knee in tumor and revision surgery. Acta Biomed. 2017;88(2S):129–38. https://doi.org/10.23750/abm.v88i2-S.6523.CrossRefPubMedPubMedCentral

11.

Roberston DD, Mintzer CM, Weissman BN, Ewald FC, LeBoff M, Spector M. Distal loss of femoral bone following total knee arthroplasty. J Bone Jt Surg. 1994;76(1):66–76.CrossRef

12.

Petersen MM, Nielsen PT, Lauritzen JB, Lund B. Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty: a 3-year follow-up of 25 knees. Acta Orthop. 1995;66(6):513–6. https://doi.org/10.3109/17453679509002305.CrossRef

13.

Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW. Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Jt Surg Br. 1993;75(2):279–87 Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8444950.CrossRef

14.

Marchetti ME, Steinberg GG, Greene JM, Jenis LG, Baran DT. A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty. J Bone Miner Res. 2009;11(7):1033–9. https://doi.org/10.1002/jbmr.5650110722.CrossRef

15.

Kröger H, Miettinen H, Arnala I, Koski E, Rushton N, Suomalainen O. 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. 2009;11(10):1526–30. https://doi.org/10.1002/jbmr.5650111020.CrossRef

16.

Rathsach Andersen M, Winther N, Lind T, Schrøder HM, Petersen MM. Bone remodeling of the proximal tibia after uncemented total knee arthroplasty: secondary endpoints analyzed from a randomized trial comparing monoblock and modular tibia trays—2 year follow-up of 53 cases. Acta Orthop. 2019;3674:479.CrossRef

17.

Andersen MR, Petersen MM. Adaptive bone remodeling of the femoral bone after tumor resection arthroplasty with an Uncemented proximally hydroxyapatite-coated stem. J Clin Densitom. 2016;19(2):202–7. https://doi.org/10.1016/j.jocd.2015.02.009.CrossRefPubMed

18.

Wada T, Kawai A, Ihara K, Sasaki M, Sonoda T, Imaeda T, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg (Br). 2007;89(5):659–63.CrossRef

19.

Petersen MM, Gehrchen PM, Nielsen PK, Lund B. Loss of bone mineral of the hip assessed by DEXA following tibial shaft fractures. Bone. 1997;20(5):491–5. https://doi.org/10.1016/S8756-3282(97)00028-8.CrossRefPubMed

20.

Venesmaa PK, Kröger HPJ, Jurvelin JS, Miettinen HJA, Suomalainen OT, Alhava EM. Periprosthetic bone loss after cemented total hip arthroplasty: a prospective 5-year dual energy radiographic absorptiometry study of 15 patients. Acta Orthop Scand. 2003;74(1):31–6. https://doi.org/10.1080/00016470310013617.CrossRefPubMed

21.

Bodén HSG, Sköldenberg OG, Salemyr MOF, Lundberg HJ, Adolphson PY. Continuous bone loss around a tapered uncemented femoral stem: a long-term evaluation with DEXA. Acta Orthop. 2006;77(6):877–85. https://doi.org/10.1080/17453670610013169.CrossRefPubMed

22.

Nygaard M, Zerahn B, Bruce C, Søballe K, Borgwardt A. Early periprosthetic femoral bone remodelling using different bearing material combinations in total hip arthroplasties: a prospective randomised study. Eur Cell Mater. 2004;8:67–5. https://doi.org/10.22203/eCM.v008a07.CrossRef

23.

Tanzer M, Kantor S, Rosenthall L, Bobyn JD. Femoral remodeling after porous-coated total hip arthroplasty with and without hydroxyapatite-tricalcium phosphate coating: a prospective randomized trial. J Arthroplast. 2001;16(5):552–8. https://doi.org/10.1054/arth.2001.23721.CrossRef

24.

Soininvaara TA, Miettinen HJA, Jurvelin JS, Alhava EM, Kröger HPJ. Bone mineral density in the proximal femur and contralateral knee after total knee arthroplasty. J Clin Densitom. 2004;7(4):424–31. https://doi.org/10.1385/JCD:7:4:424.CrossRefPubMed

25.

Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, et al. Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. A five-year longitudinal study. J Bone Jt Surg - Br Vol. 2004;86(1):20–6.CrossRef

26.

Huang Q, Shen B, Yang J, Zhou Z k, de Kang P, xing PF. Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty. J Arthroplasty. 2013;28(10):1811–5. https://doi.org/10.1016/j.arth.2013.03.020.CrossRefPubMed

27.

Korovessis P, Droutsas P, Piperos G, Michael A, Baikousis A, Stamatakis M. Course of bone mineral content changes around cementless Zweymueller total hip arthroplasty: a 4-year follow-up study. Arch Orthop Trauma Surg. 1997;116(1–2):60–5. https://doi.org/10.1007/BF00434103.CrossRefPubMed

28.

Jensen CL, Petersen MM, Schrøder HM, Lund B. Changes in bone mineral density of the distal femur after revision total knee arthroplasty with metaphyseal press-fit stem. J Orthop Traumatol. 2010;11(3):143–8. https://doi.org/10.1007/s10195-010-0098-7.CrossRefPubMedPubMedCentral

29.

van Lenthe GH, Willems MMM, Verdonschot N, de Waal Malefijt MC, Huiskes R. Stemmed femoral knee prostheses. Acta Orthop Scand. 2002;73(6):630–7. https://doi.org/10.1080/000164702321039589.CrossRefPubMed

30.

Brockstedt H, Kassem M, Eriksen EF, Mosekilde L, Melsen F. Age- and sex-related changes in iliac cortical bone mass and remodeling. Bone. 1993;14(4):681–91. https://doi.org/10.1016/8756-3282(93)90092-O.CrossRefPubMed

31.

Tunn PU, Pomraenke D, Goerling U, Hohenberger P. Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours - a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop. 2008;32(5):619–25. https://doi.org/10.1007/s00264-007-0388-8.CrossRefPubMed

32.

Lan F, Wunder JS, Griffina M, Davisa M, Bell RS, White LM, et al. Periprosthetic bone remodelling around a prosthesis for distal femoral tumours. Measurement by dual-energy X-ray absorptiometry (DEXA). J Bone Jt Surg - Br Vol. 2000;82(1):120–5. https://doi.org/10.1302/0301-620X.82B1.0820120.CrossRef

33.

Gehrchen PM, Petersen MM, Nielsen PK, Lund B. Influence of region size on bone mineral measurements along femoral stems in THA. HIP Int. 2000;10(4):204–8. https://doi.org/10.1177/112070000001000403.CrossRef

34.

Seki T, Omori G, Koga Y, Suzuki Y, Ishii Y, Takahashi HE. Is bone density in the distal femur affected by use of cement and by femoral component design in total knee arthroplasty? J Orthop Sci. 1999;4(3):180–6. https://doi.org/10.1007/s007760050091.CrossRefPubMed

Title: Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry
Authors: Christina Enciso Holm
Peter Horstmann
Michala Skovlund Sørensen
Karen Dyreborg
Michael Mørk Petersen
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04395-2

At a glance: The STEP trials

Springer Medicine

Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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