Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study

Lerch, Matthias; Haar-Tran, Annelene von der; Windhagen, Henning; Behrens, Bernd‐Arno; Wefstaedt, Patrick; Stukenborg-Colsman, Christina

doi:10.1007/s00264-011-1361-0

Cited by 110 publications

(136 citation statements)

References 26 publications

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“…Excellent clinical and radiographic mid-term results have been reported, but most of the short stems have not been able to reduce BMD loss in the proximal femoral regions (Albanese et al 2009, Chen et al 2009, Gotze et al 2010, Lerch et al 2012, Lazarinis et al 2013). …”

Section: Discussionmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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“…We thank Mr. Diamond and Mr. McAlinden for their interest in our article [1]. We agree that a comparison of the two stems might be of interest, but only at first glance.…”

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confidence: 91%

Reply to comments on the article: Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study

Lerch

Stukenborg-Colsman

2011

International Orthopaedics (SICOT)

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“…In response, several authors have proposed that the theoretical risk of impingement can be mitigated by positioning the acetabular cup to subtend an angle of 140° [ 16]. With regards to the risk of calcar resorption, radiological analyses of neck retaining prostheses have demonstrated preservation of the entire calcar region [21,25]. This, however, is likely to be dependent on individual implant design and stiffness.…”

Section: Introductionmentioning

confidence: 99%

Neck-Preserving Femoral Stems

Rajakulendran

Field

2012

HSS Jrnl

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Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages. Purposes: The objectives of this study were to review:(1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems. Methods: A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct. Results: Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known. Conclusions: Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate on-going bone remodelling and assess implant performance and survival.

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Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study

Cited by 110 publications

References 26 publications

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Reply to comments on the article: Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study

Neck-Preserving Femoral Stems

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