Bone remodelling after femoral short stem implantation in total hip arthroplasty: 1-year results from a randomized DEXA study

Freitag, Tobias; Hein, Marie-Anne; Wernerus, D.; Reichel, Heiko; Bieger, Ralf

doi:10.1007/s00402-015-2370-z

Cited by 68 publications

(80 citation statements)

References 20 publications

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“…All but 1 of the 6 studies included patients with osteoarthritis, osteonecrosis, traumatic arthritis, and femoral neck fracture [16] . Of the 6 included studies, 3 used posterolateral approaches, [ 9 10 17 ] 2 used a direct lateral approach, [ 18 19 ] and 1 used a minimally invasive anterolateral approach [16] . There was adequate random sequence generation in 2 studies, [ 9 17 ] but 4 articles did not report it.…”

Section: Resultsmentioning

confidence: 99%

“…There was adequate random sequence generation in 2 studies, [ 9 17 ] but 4 articles did not report it. [ 10 16 18 19 ] The studies included a total of 265 patients using SSs, with a total of 287 patients using CSs. The individual sample sizes of the studies ranged from 43 to 140 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The measurement of femoral offset and leg-length discrepancy was based on these images. Four studies reported that weight bearing on the affected limb was allowed as comfort permitted, [ 9 10 16 18 ] 1 reported immediate full weight-bearing after surgery using 2 crutches, [19] but 1 did not describe this point [17] . Thigh pain was scored based on a 10-point visual analog scale in 2 studies, [ 9 17 ] but another study reported thigh pain graded as none, mild, moderate, or severe [10] .…”

Section: Resultsmentioning

confidence: 99%

“…HHS was examined in these 6 studies [ 9 10 16–19 ] and WOMAC in 5 studies. [ 9 10 16 18 19 ] The postoperative self-reported measures (HHS, WOMAC) were greatly improved comparing to the preoperative ones in the 2 designs of stems.…”

Section: Discussionmentioning

confidence: 99%

“…[ 9 10 16 18 19 ] The postoperative self-reported measures (HHS, WOMAC) were greatly improved comparing to the preoperative ones in the 2 designs of stems. Our meta-analysis found strong evidence indicated no difference in HHS and WOMAC when comparing SSs to CSs after THA.…”

Section: Discussionmentioning

confidence: 99%

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Short-stem prostheses in primary total hip arthroplasty

et al. 2016

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Background:Short-stem (SS) prostheses require less resection of the femoral neck, produce a more physiological load pattern in the proximal femur, reduce stress shielding, and aid bone conservation and are, therefore, beneficial for young patients. Conventional cementless implants in total hip arthroplasty (THA) have shown excellent clinical results; however, it is unclear whether SS prostheses can obtain the same clinical and radiological outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate whether SS prostheses are superior to conventional implants after primary THA.Methods:We reviewed the literature published up to June 2016 from PubMed, Web of Science, and the Cochrane Library to find relevant RCTs comparing SSs and conventional stems in primary THA. Quality assessment was performed by 2 independent reviewers. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. Random- or fixed-effect models were used to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for each comparison.Results:Six RCTs involving 552 patients with 572 hips were identified. Strong evidence indicated that SS prostheses were more effective for reducing thigh pain than conventional implants (I 2 = 46%, P = 0.002; risk ratio [RR], 95% CI 0.15, 0.04–0.49). However, there were no significant differences between the 2 groups in Harris Hip Scores (I 2 = 0%, P = 0.84; SMD, 95% CI 0.02, −0.15–0.18), Western Ontario and McMaster Universities Osteoarthritis Index Scores (I 2 = 0%, P = 0.35; SMD, 95% CI 0.09, −0.10–0.27), femoral offset of stem (I 2 = 0%, P = 0.57; SMD, 95% CI 0.06, −0.16–0.29), and leg-length discrepancy (I 2 = 79%, P = 0.88; SMD, 95% CI 0.04, −0.44–0.51).Conclusion:SS prostheses achieve the same clinical and radiological outcomes as conventional implants, and were superior in terms of reducing thigh pain. But whether the postoperative thigh pain applied in 2nd-generation cementless prosthesis still needs further large-scale multicenter studies with longer follow-up to confirm.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Short-stem prostheses in primary total hip arthroplasty

et al. 2016

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Bone remodeling after revision total hip arthroplasty for large acetabular defects

Ramesh,

Di Laura,

De Angelis

et al. 2024

Journal Orthopaedic Research

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Large acetabular bone defects are challenging in hip revision surgery. Clinical assessment is crucial to evaluate modern technologies in surgical reconstruction. We aimed to better understand the bone remodeling that occurs following acetabular reconstruction. Our objectives were: (1) To characterize changes in the shape of the pelvis by studying sequential computed tomography (CT) scans collected immediately and 1‐year postoperatively and (2) to identify which part of the pelvis is most susceptible to remodeling. We used the CT scans taken at two timepoints, of 24 patients with acetabular bone defects classified as Paprosky IIIB, treated with three‐dimensional (3D)‐printed custom‐made acetabular implants. Segmented 3D models of the bony pelvis were co‐registered using three different techniques. A global co‐registration of the full pelvis was conducted, followed by the co‐registration of the innominate bone and then ilium only, on the ipsilateral reconstructed side. The relative movements of the ilium, ischium, and pubis were analyzed from visual inspection and using co‐registration metrics (root mean square error and intersection over union). No bone remodeling was found in 14/24 patients (58%). The co‐registration of the innominate bone indicated bone remodeling in five cases (21%), while the remaining five cases (21%) presented remodeling in the global co‐registration but not the innominate bone co‐registration, suggestive of changes occurring at the sacroiliac joint. Changes in the pelvic shape were greatest at the pubis and ischium. Bone remodeling may occur in complex cases of Paprosky type IIIB defects, after acetabular reconstruction (occurrence of 21%, 5/24 cases). Surgeons and engineers should consider this when monitoring implant migration.

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