Definition of endoprosthetic loosening: Comparison of arthrography, scintigraphy and roentgen stereophotogrammetry in prosthetic hips

Mjöberg, Bengt; Brismar, J.; Hansson, Lars; Pettersson, Holger; Selvik, Göran; Önnerfält, Rolf

doi:10.3109/17453678508993037

Cited by 51 publications

(16 citation statements)

References 19 publications

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“…For cemented stems, this was suggested by Mjoberg et 01. [12], and confirmed by Karrholm etal. [13], using highly accurate roentgen stereophorogrammerric analysis (RSA).…”

Section: Fixation and Interface Mechanicssupporting

confidence: 58%

Biomechanics of noncemented total hip arthroplasty

Huiskes¹

1996

Current Opinion in Orthopaedics

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“…For cemented stems, this was suggested by Mjoberg et 01. [12], and confirmed by Karrholm etal. [13], using highly accurate roentgen stereophorogrammerric analysis (RSA).…”

Section: Fixation and Interface Mechanicssupporting

confidence: 58%

Biomechanics of noncemented total hip arthroplasty

Huiskes¹

1996

Current Opinion in Orthopaedics

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“…A method of predicting implant performance as soon as possible after implantation is needed, and roentgen stereophotogrammetric analysis (RSA) has this potential. It has been shown for some types of implant that RSA can detect abnormalities before there are clinical or radiological signs of loosening (Green et al 1983;Mjöberg, Hansson and Selvik 1984b;Chafetz et al 1984;Nistor et al 1991;Kärrholm and Snorrason 1993), and that there is a good correlation between increased migration and early loosening (Mjöberg et al 1985;Snorrason and Kärrholm 1990;Franzén, Mjöberg and Ö nnerfält 1992;Kärrholm and Snorrason 1993;Freeman and PlanteBordeneuve 1994). There is little information from RSA studies, however, about the rate or pattern of migration which predicts early loosening of the cemented femoral components (Kärrholm et al 1994).…”

mentioning

confidence: 99%

Migration of Cemented Femoral Components After THR

Kiss

Murray

Turner-Smith

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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We studied the migration of 58 cemented Hinek femoral components for total hip replacement, using roentgen stereophotogrammetric analysis over four years. The implants migrated faster during the first year than subsequently, and the pattern of migration in the second period was very different. During the first year they subsided, tilted into varus and internally rotated. After this there was slow distal migration with no change in orientation. None of the prostheses has yet failed.The early migration is probably caused by resorption of bone damaged by surgical trauma or the heat generated by the polymerisation of bone cement. Later migration may be due to creep in the bone cement or the surrounding fibrous membrane.The prosthesis which we studied allows the preservation of some of the femoral neck, and comparison with published migration studies of the Charnley stem suggests that this decreases rotation and may help to prevent loosening.

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“…Early changes at the bone-cement interface cannot be demonstrated by the currently employed, noninvasive investigations; the diagnosis of loosening is based on the detection of bone resorption around the implant by standard roentgenography or arthrography; other signs include migration of the prosthetic components or instability, which can be demonstrated by more sophisticated methods as such roentgen stereophotogrammetric analysis [10,11]. However on the basis of pathological changes at the bone-cement interface observed in this study, the process leading to loosening is far advanced when instability occurs, or before periprosthetic bone resorption may be detected on radiograms.…”

Section: Discussionmentioning

confidence: 99%

Pathology of the bone-cement interface in loosening of total hip replacement

Pazzaglia

1990

Arch Orthop Trauma Surg

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The histopathology of the bone-cement interface in nine retrieved hip prostheses is reported. Three cases presented features similar to those observed by Charnley in highly successful implants, and they were classified as stable prostheses, although signs of periprosthetic bone resorption were already present. In this group a macrophagic reaction was evident even in the presence of a stable bone-cement interface, supporting the view that the release of particles by the cement or by the prosthetic components can precede the mechanical instability and be the primary cause of loosening. In six prostheses the connective tissue layer between the cement and the bone was thick and no bone trabecula reached the cement surface. The polymorphous features of this connective membrane probably resulted from instability and movement at the bone-cement and stem-cement interfaces. On the basis of the pathological changes observed in the study, the process of loosening must be far advanced before it is detected on radiographs; it is suggested that scintigraphy is the best noninvasive technique to demonstrate macrophage activation and increased bone remodeling around the cement in the early phases of loosening.

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Definition of endoprosthetic loosening: Comparison of arthrography, scintigraphy and roentgen stereophotogrammetry in prosthetic hips

Cited by 51 publications

References 19 publications

Biomechanics of noncemented total hip arthroplasty

Biomechanics of noncemented total hip arthroplasty

Migration of Cemented Femoral Components After THR

Pathology of the bone-cement interface in loosening of total hip replacement

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