Maintenance of proximal bone mass with an uncemented femoral stem analysis with dual-energy x-ray absorptiometry

Wixson, Richard L.; Stulberg, S. David; Flandern, Geoffrey J. Van; Puri, Lalit

doi:10.1016/s0883-5403(97)90191-1

Cited by 65 publications

(42 citation statements)

References 15 publications

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“…A number of prospective studies of uncemented femoral implants have shown a significant bone loss (10-40%) in the calcar region after 1 4 years [S,lS, 23,26,27,30,34,35]. Our findings of the Unique stem are in agreement with this.…”

Section: Bone-mineral Densitysupporting

confidence: 90%

“…The bone loss that we found for the Elite Plus was similar to what Cohen found for the Charnley prosthesis after 1 year [l 11. Some studies following patients up to 10 years have shown a progressive recovery or a minimal loss of BMD after the first to second postoperative year [ 16,20,30,34]. A different pattern of BMD changes has been found around loosened implants [9,23,31,32].…”

Section: Bone-mineral Densitymentioning

confidence: 99%

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Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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The custom made Unique® stem is designed to fit closely to the metaphyseal region of the femur in order to obtain maximum mechanical stability and optimal load transfer. Thirty‐seven patients (38 hips) with non‐inflammatory arthritis were randomized to the uncemented custom made Unique® stem or the Elite Plus stem inserted with cement. The patients have been followed clinically as well as with radiostereometry (RSA) and Dual‐energy X‐ray Absorptiometry (DXA) for 2 years. After 2 years the RSA result showed minimal translation and rotation for the Unique® stem while the Elite Plus rotated slightly (mean 1.05°) into retroversion. Compared to previous studies the Elite Plus was as stable as the Charnley prosthesis. The DXA results showed a significantly higher proximal and total (10% for the Unique versus 5% for Elite) bone loss for the Unique® stem compared to the Elite Plus. Thus the optimal proximal press‐fit of the custom made stem did secure a stable fixation, but did not decrease the proximal bone loss. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Section: Bone-mineral Densitysupporting

confidence: 90%

Section: Bone-mineral Densitymentioning

confidence: 99%

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Grant¹,

Aamodt

Falch³

et al. 2005

J. Orthop. Res.

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“…A large degree of bone loss of the proximal femur has been identified in longitudinal studies as early as 3-6 months after implantation of an uncemented stem; thereafter, the BMD stabilizes during the first postoperative year (Marchetti et al 1996, Nishii et al 1997, Wixson et al 1997, Kröger et al 1998. None of our patients were measured until 2 years after surgery.…”

Section: Discussionmentioning

confidence: 90%

Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2–7 years

et al. 2006

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Background Periprosthetic bone loss occurs around uncemented femoral stems and may be influenced by the stem size.Patients and methods We studied 138 consecutive patients, 3 (2-7) years on average after a total hip arthroplasty operation (THA) for unilateral osteoarthritis with the Bi-Metric uncemented femoral stem. We analyzed Harris hip score and bone mineral density.Results The mean Harris hip score was 97 at followup. Bone mineral density decreased proximally by 19% in both Gruen zones 1 and 7. Bone loss in zones 1, 2, 6, and 7 was significantly associated with stem size. Distally, a small gain in bone mass was found in zones 3 and 5 for medium femoral sizes.Interpretation We found a marked proximal BMD loss, especially for the larger stems, which may be specific for this particular implant. Long-term studies should reveal whether this proximal bone loss will affect the longevity of the THA.

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“…At the calcar region a 28% mean loss of BMD has been reported with an extensively porous-coated stem [23], a 34% mean loss with a proximally porous-coated cobalt-chromium stem [17], 15-28% mean loss with proximally porous-coated titanium stems [17,53] and 20% with proximally porouscoated titanium supermodular stems [42]. The respective loss in calcar density was only 12% with titanium custom-made stems [51,53] and even some increase in the BMD of the calcar has been reported with stemless femoral implants [35].…”

Section: Five-year Radiological Resultsmentioning

confidence: 99%

“…In the ABG design concept the combination of a distal over-reaming technique and proximal hydroxyapatite coating is reasonable and the clinical results seem to be reliable [1,47]. The idea of a perfect fitand-fill along the endosteal cortex from metaphysis to diaphysis was introduced with the development of custom-made stems [7,41] but current opinion would probably be that these devices should be designed to fit only to the metaphysis and to remain distally loose or at least distally polished [51].…”

Section: Five-year Radiological Resultsmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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We measured the post-operative radiological "fit and fill" of two different femoral stem designs, one with a straight proximally porous-coated n=50) and the other with a proximally anatomic, hydroxyapatite-coated and distally over-reamed stem (ABG, n=26). A comparison was then made between the clinical and radiological 5-year follow-up data of these two series and also of the bone remodeling changes around the stems. The observed differences in "fit and fill" parameters in the metaphyseal region were minute. However, in the diaphyseal bone the straight stem had substantially more cortical contact. The clinical results were excellent for both groups. Subsidence (>2 mm) was more frequent with the anatomical ABG stems, although the ABG stems had better bone ingrowth in the lower metaphyseal area. The present results indicate that the anatomical design may improve the fit and fill of a femoral stem in the metaphysis. On the other hand, a looser fill of the diaphyseal bone made the stems of this type more susceptible to subsidence. The straight stem with tight diaphyseal fit showed excellent stability, but the good bone ingrowth and remodeling around the distal part of the stem indicates stress transfer through this region and increased stress shielding of the proximal metaphyseal femur.Résumé Nous avons mesuré l'adaptation et le remplissage radiographique postopératoire de deux modèles diffé-rents de tiges fémorales, une tige droite avec la porosité proximale (BI-Metric, n=50) et une tige proximalement anatomique revêtue d'hydroxyapatite avec un surfaçage distal (ABG, n=26). Nous avons comparé les renseignements cliniques et radiographiques de ces deux séries de données résultant d'un suivi de cinq ans. Le remodelage osseux autour des tiges a été pris en compte. Les diffé-rences observées dans les paramètres de l'adaptation et de remplissage dans la région métaphysaire étaient minimales. Par contre dans la région diaphysaire la tige droite faisait montre de plus de contact cortical et ceci d'une manière significative. Les résultats cliniques sur ces deux groupes furent excellents. L'enfoncement (>2 mm.) de tiges anatomiques ABG était plus fréquent. Les résul-tats présentés indiquent que le modèle anatomique pourrait améliorer l'adaptation et le remplissage de la tige fé-morale dans la région de l'os métaphysaire.

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Maintenance of proximal bone mass with an uncemented femoral stem analysis with dual-energy x-ray absorptiometry

Cited by 65 publications

References 15 publications

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry

Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2–7 years

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

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