A proximal fixed anatomic femoral stem reduces stress shielding

Niinimäki, Tuukka; Junila, J.; Jalovaara, P.

doi:10.1007/s002640100241

Cited by 45 publications

(38 citation statements)

References 11 publications

(13 reference statements)

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“…Most of the remodelling is established at the end of the first post-operative year, when the BMD seems to reach a plateau in all of the areas around the stem [6,9,17,22,24]. The results of our study suggest that this stability appears between the sixth and twelfth months, reflecting the biomechanical response of the bone according to Wolff's law.…”

Section: Discussionmentioning

confidence: 51%

“…Recently, femoral stems with reduced stiffness showed a 15% reduction of BMD in the calcar at the end of the second year [7,9,16]. The patterns of remodelling produced by these anatomic, cementless stems were similar to those shown by other second-generation cementless stems [6,9,17].…”

Section: Discussionmentioning

confidence: 52%

“…c At five years follow-up, this stem seem to have cause a reduced loss of bone density in proximal areas, with similar changes in the middle and distal parts around the stem In previous DEXA studies, first-generation cementless stems (usually straight, collared, extensively coated) showed proximal bone loss that reached up to 45% BMD at 24 post-operative months [14,22,23]. Second-generation cementless stems (anatomic design, metaphyseal press-fit, proximal coating) made of titanium still had a decrease of BMD at the end of the second year that ranged from 20% to 25% [9,17]. Tapered femoral components had a proximal loss between 10% to 30% [1,6,19].…”

Section: Discussionmentioning

confidence: 99%

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Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem

Panisello

Canales

Herrero

et al. 2008

International Orthopaedics (SICOT)

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The aim of this prospective cohort study was to determine the densitometric relevance of minor design modifications of a cementless stem designed to improve proximal load transfer. We used a prospective cohort study with densitometric analysis over a five-year period of two groups of patients with primary osteoarthritis. The first group, 56 hips, received the first version of the ABG stem (ABG-I); the second group, 54 hips, had the ABG-II stem. The results obtained with the ABG-I stem showed a decrease of bone density in proximal areas that ranged from 13% to 37%. However, the new design had a decrease of the same areas that ranged from 9% to 23%. These differences were noted at the end of the first post-operative year and remained stable, except in zone 7, where they were progressive. There is little evidence that the modified stem reduces femoral bone density loss.Résumé Nous avons revu de façon rétrospective 68 hanches chez 62 patients présentant une dysplasie acétabulaire et ayant bénéficié d'une ostéotomie péri-acétabulaire. Parmi ces 68 hanches, 33 avaient en préopératoire une rétroversion acétabulaire (groupe rétroversion) et 35 une antéversion (groupe contrôle). Toutes les hanches ont été évaluées selon le score de Harris. L'évaluation radiographique de la rétroversion acétabulaire et du mur postérieur déficient ont été basées sur le signe du croisement et le signe du mur extérieur. Les scores cliniques des deux groupes au suivi final était semblable. Dans le groupe rétroversion, 12 hanches avaient antéversé leur acétabulum en post-opéra-toire le signe du mur postérieur disparaissant, mais celui-ci restant présent dans 21 hanches avec un acétabulum en rétroversion post-opératoire. Parmi les 21 hanches avec acétabulum rétroversé une coxarthrose postérieure s'est développée à 5 ans post-opératoire. Lorsque l'on réalise une correction par ostéotomie pour une hanche dysplasique avec un acétabulum rétroversé, il est important de corriger cette rétroversion de façon à prévenir une coxarthrose secondaire due à la déficience du mur postérieur.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem

Panisello

Canales

Herrero

et al. 2008

International Orthopaedics (SICOT)

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“…Studies on uncemented stems have shown partial BD recovery after an initial postoperative bone loss [11,17]. Similarly, a study carried out on HA-coated tapered stems reported a BD decrease in the 1st postoperative year with a recovery at the 3-year follow-up [15].…”

Section: Discussionmentioning

confidence: 94%

Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

Pitto

Bhargava

Pandit

et al. 2007

International Orthopaedics (SICO

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The aim of this prospective study was to measure bone density changes and to assess adaptive bone remodelling after uncemented total hip arthroplasty with a taper-design femoral component using quantitative computer-tomographyassisted osteodensitometry. This method is able to differentiate cortical and cancellous bone structures. Twenty-seven consecutive patients (29 hips) with degenerative joint disease were enrolled in the study. Serial clinical, radiological and CTosteodensitometry assessments were performed after the index operation. At the 2-year follow-up, the clinical outcome was rated satisfactory in all hips. The radiological assessment showed signs of osteointegration and stable fixation of all cups and stems. We observed a −17% decrease of cortical bone density and −22% decrease of cancellous bone density in the greater trochanter and femoral neck region. Cortical and cancellous bone density decrease at the level of the lesser trochanter was −9% and respectively −4%. We observed small changes of cortical bone density in the diaphyseal regions; in contrast, cancellous bone density increased (range 6% to 27%) in the diaphyseal regions. Overall, a trend of bone density recovery was observed throughout the follow-up period. Periprosthetic bone density changes at the 2-year follow-up are suggestive of stable osteointegration with proximal femoral diaphysis load transfer and moderate metaphyseal stress-shielding.Résumé Le but de cette étude prospective est de mesurer par scanner et ostéodensitométrie la densité osseuse et le remodelage osseux après prothèse non cimentée. Cette méthode permet de différencier les structures osseuses corticales et spongieuses. 27 patients consécutifs (29 hanches) présentant une coxarthrose ont été inclus dans cette étude qui a comporté une analyse radiologique, scanographique et ostéo-densitométrie. Pour toutes les hanches à deux ans de suivi post-opératoire, le devenir clinique de ces patients était satisfaisant. La radiologie montrait des signes d'ostéointégra-tion et de fixation stables dans toutes les cupules et pour toutes les pièces fémorales. Nous avons observé une diminution de 17% de la densité corticale et de 22% de la densité de l'os spongieux au niveau du grand trochanter et au niveau du calcar. Il existe également une diminution de la densité osseuse au niveau du petit trochanter tant sur le plan cortical 9% qu'au niveau de l'os spongieux 4%. Nous avons égale-ment observé de petites modifications de la densité osseuse corticale au niveau de la région diaphysaire, a contrario nous avons également mis en évidence une augmentation de la densité osseuse de l'os spongieux à ce niveau (de 6 à 27%). Ces différentes modifications osseuses nous permettent, à deux ans de suivi post-opératoire, de penser que l'ostéointégration proximale des éléments prothétiques entraîne un transfert de charge et un stress-shielding métaphysaire modéré.

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“…The topic has been investigated and discussed in several studies (Engh and Bobyn 1988, McCarthy et al 1991, Engh et al 1992a, Maloney et al 1996, Bugbee et al 1997, Van Lenthe et al 1997. Stress shielding around a femoral intramedullary implant may depend on the stiffness of the implant (Engh et al 1987, Engh and Bobyn 1988, Wan et al 1999; it has been demonstrated in dogs that a small implant without press-fit distally results in less stress shielding than a press-fit implant (Engh et al 1987, Niinimaki et al 2001. Harvey et al (1999) investigated the effect of bony ingrowth and stress shielding on femoral stem stiffness.…”

Section: Stress Shieldingmentioning

confidence: 99%