A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty

Abstract

Cross-sectional studies have demonstrated significant decreases in bone mass in femoral cortical bone adjacent to prostheses. Thirty-six patients who had undergone 31 cemented and 9 uncemented primary total hip arthroplasties (THA) were prospectively studied to define further the natural history of this femoral cortical bone loss. Dual-energy X-ray absorptiometry (DXA) was employed to quantify bone mineral density (BMD) changes in four subregions around the femoral prostheses. Femoral BMD loss (average 12.3%) was observed in the three proximal subregions 2 months postoperatively. This loss increased to 21.2% by 6 months postoperatively, and by 2 years postoperatively it averaged 25.5% in the same three subregions. There were no significant BMD changes in the subregion distal to the prosthesis tip or in the contralateral hip. Subgroups were compared based on prosthesis size and cement use. Statistically significant differences in BMD loss were observed between the large cemented cobalt chrome prosthesis group (n = 8) and the large uncemented titanium prosthesis group (n = 8). These differences were only present in the most proximal medial subregion where the large cemented groups had twice the bone loss in this area as compared with the large uncemented group. The data indicate that bone loss occurs adjacent to femoral prosthesis within 2 months of surgery and that DXA is a useful technique to quantify prospectively femoral cortical bone loss following THA.

Changes in bone mineral density (BMD) around the cemented Exeter stem: A prospective study in 18 women with 5 years follow‐up

“…It has been stated previously that cementation, and the components of cement, give artefacts in the measurements of BMD (Venesmaa et al 2003). Some authors have therefore tried to subtract the cement mantle in the scan (Marchetti et al 1996), while others have found this impossible (McCarthy et al 1991, Cohen andRushton 1995). In our study, we were unable to distinguish between bone and cement mantle.…”

“…Reduced strength of bone around the stem after THA (McCarthy et al 1991) might cause loosening of the stem and increase the risk of fractures around the stem after a fall. Dual-energy X-ray absorptiometry (DXA) is a well-documented method of monitoring after THA (Marchetti et al 1996, Spittlehouse et al 1998) and detects even small changes in bone mineral density (BMD) around the stem (Kilgus et al 1993, Kröger et al 1996. Most previous publications on periprosthetic BMD describe patients with uncemented THA.…”

Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

“…1 In the last century increasing knowledge of load transfer mechanisms and stress distribution patterns after total hip replacements was provided. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of these studies have focussed on stress shielding mechanisms after femoral stem implantation. [2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of these studies have focussed on stress shielding mechanisms after femoral stem implantation. [2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique. [2][3][4][5][6][7]11,[15][16][17] To allow a differentiated three-dimensional analysis of cortical and cancellous bone structures after THA in vivo we have introduced a novel method of CT-assisted osteodensitometry.…”

“…[2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique. [2][3][4][5][6][7]11,[15][16][17] To allow a differentiated three-dimensional analysis of cortical and cancellous bone structures after THA in vivo we have introduced a novel method of CT-assisted osteodensitometry. 9,10,13,14 In a previous study we have provided clear evidences for the reproducibility and validity of our method.…”