Acetabular cortical and cancellous bone density and radiolucent lines after cemented total hip arthroplasty: a prospective study using computed tomography and plain radiography

Abstract

CT-osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling: sufficient cancellous and cortical bone stock remained dorsal and cranial to the cup indicative of a balanced load transfer to these regions. CT-osteodensitometry has the potential to become an effective instrument for quality control in THA and the method of choice for in vivo determination of periprosthetic BD. In contrast, plain radiography is more suitable for the early detection of radiolucent lines compared to axial CT scans.

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

“…[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. 9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty.…”

“…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.…”

“…[19][20][21] Consistent with this notion, we have shown in a previous study with a smaller cohort (n ¼ 15) of cemented cups and a less precise three region of interest evaluation, that a significant cancellous BD decrease is detectable solely ventral to the cemented cup, but not dorsal or cranial to the implant. 14 …”

“…9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty. 13,14 A DXA based study by Sabo et al 11 showed a decrease of periacetabular BD 24 months after implantation of a rigid press fit cup. The BD decrease was highest craniolateral to the inserted cup (À16%) and lowest medially to the cup (À12%).…”

“…[19][20][21] Consistent with this notion, we have shown in a previous study with a smaller cohort (n ¼ 15) of cemented cups and a less precise three region of interest evaluation, that a significant cancellous BD decrease is detectable solely ventral to the cemented cup, but not dorsal or cranial to the implant. 14 In this study, we used CT-assisted osteodensitometry in two prospectively analyzed cohorts of patients to evaluate possible differences in the load transfer mechanism to the periprosthetic bone stock after cemented versus noncemented press-fit cup fixation 26 months after index operation.…”