Bone remodelling around the Metha ® short stem implant – Clinical and dual-energy x-ray absorptiometry (DXA) results

Fischer, Markus; Beckmann, Nicholas A.; Simank, H.-G.

doi:10.1016/j.jor.2017.08.007

Cited by 8 publications

(9 citation statements)

References 22 publications

(39 reference statements)

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“…Densitometry showed an increase in bone mineral density in the proximal and distal lateral zones around the Metha stem and a decrease in bone mineral density in the proximal medial and central lateral zones around the tested implant. The reported observation confirms the process of remodelling and healing of the stem into the mataphyseal region of the proximal femoral bone 37 .…”

Section: Discussionsupporting

confidence: 85%

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Drobniewski

Synder

Krasińska

et al. 2021

Sci Rep

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The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d’Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan–Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.

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Section: Discussionsupporting

confidence: 85%

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Drobniewski

Synder

Krasińska

et al. 2021

Sci Rep

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“…Consequently, short hip stems and even neck stems have become the latest concepts. These stems help preserve the femoral neck, keep the anatomical elasticity of the femur and introduce the forces in the upper part of the femur [18,51,[58][59][60][61][62][63][64]. And studies evaluated periprosthetic bone remodeling with DEXA showed a more balanced remodeling and favorable load transfer of the short stem in comparison to standard hip stem [16,51,[60][61][62][63][64][65].…”

Section: Implant-related Factorsmentioning

confidence: 99%

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Tian

et al. 2019

BioMed Research International

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Background. Femoral bone remodeling around hip prosthesis after total hip arthroplasty (THA) is definite but unpredictable in time and place. This study aimed to investigate the implant-specific remodeling and periprosthetic bone mineral density (BMD) changes after implantation of the Ribbed anatomic cementless femoral stem. Methods. After power analysis, 41 patients who had undergone primary unilateral THA with the Ribbed anatomic cementless stem were included. BMD of the seven Gruen zones was measured by dual-energy X-ray absorptiometry, and the contact, fitness, and fixation of the femoral stem and proximal femur were analyzed by X-ray. Additional clinical outcome parameters were also recorded. Results. Compared with the contralateral unoperated side, significant reductions of BMD were detected in the distal zone (Gruen zone 4: 1.665±0.198 versus 1.568±0.242 g/cm2, P=0.001) and middle distal zone (Gruen zone 5: 1.660±0.209 versus 1.608±0.215 g/cm2, P=0.026) on the prosthetic side, but no significant differences in BMD were detected in other zones (Gruen zones 1, 2, 3, 6, and 7). Subgroups analyses indicated no significant correlation between periprosthetic BMD changes and clinical factors including primary disease and body mass index. Visible areas of bone ingrowth indicated solid fixation of the femoral stem and there was no case of loosening. Clinical and functional outcome scores were excellent with mean HHS of 93.13 points and mean WOMAC score of 5.20 points, and three patients described intermittent mild thigh pain at the final follow-up. Conclusions. For the Ribbed femoral stem, the periprosthetic BMD was well maintained in the proximal femur, while periprosthetic BMD was significantly reduced in the distal and middle distal zones of the femur. Further clinical investigations are required to examine the efficacy of the Ribbed stem, particularly with regard to long-term survival. This trial is registered with ChiCTR1800017750.

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“…Some authors investigated the bone remodelling characteristics of the femur after THA with a METHA stem by using DEXA assessment and adapting Gruen zones (R1 to R7) to the short stem design. 89 – 92 In all studies including 176 hips with at least one year of follow-up, the bone mineral density (BMD) significantly increased in the lateral regions (R2 and R3) and significantly decreased in the proximal regions (R1 and R7). On the other hand, changes in distal (R4), distal-medial (zone 5) and lesser trochanter (R6) regions were less relevant and reliable across the analysed studies.…”

Section: Stem Features and Outcomesmentioning

confidence: 99%

Uncemented short stems in primary total hip arthroplasty

Loppini

Grappiolo

2018

EFORT Open Reviews

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Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain.All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture.Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling.Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052

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Bone remodelling around the Metha ® short stem implant – Clinical and dual-energy x-ray absorptiometry (DXA) results

Abstract: The concept of metaphyseal ingrowth was confirmed, but distal bony reactions need further investigation.

Cited by 8 publications

References 22 publications

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Uncemented short stems in primary total hip arthroplasty

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