No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial

Schilcher, Jörg; Ivarsson, Ingemar; Perlbach, Rico; Palm, Lars

doi:10.1016/j.arth.2016.11.015

Cited by 30 publications

(38 citation statements)

References 36 publications

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“…A similar result to this was observed in a recent study, which compared bone remodelling between a standard length cementless stem and a shorter cementless stem in all seven Gruen zones at two years. At the end of the follow up, they did not find any statistically significant differences in periprosthetic bone loss between the two stems (28).…”

Section: Discussionmentioning

confidence: 83%

Adaptive Bone Remodeling With New Design of the ABG Stem. Densitometric Study

López-Subías

Panisello

Mateo-Agudo

et al. 2019

Journal of Clinical Densitometry

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Introduction: In order to establish the pattern of bone remodelling caused by a cementless, anatomic implant, we intend to evaluate the changes in bone mineral density observed after surgery in the Gruen zones. Material & methods: A controlled, prospective study was carried out, in which a group of 37 patients suffering from primary coxarthrosis were densitrometrically analyzed over the one year period following the implant of an ANATO® stem (Stryker®). The patient's healthy hip was taken as the control. Any differences in the remodelling pattern were compared according to age, body mass index and implant size. Results: Decreases in bone mineral density were observed after 3 months in all of the zones studied. However, this bone mineral density loss was recovered in all zones by the end of the study, except in zone 7 where a decrease of 7.2% in bone mass was observed. In zones 2 and 6, where more loads are transmitted, bone mass preservation, in accordance with Wolff's law, can be seen. No differences were found in the remodelling pattern in relation to age and body mass index. Neither were there any differences related to stem size except in zones 1 and 7. Conclusion: the ANATO® stem achieves an efficient transmission of loads between the stem and the proximal femur, providing enough mechanical loads for bone preservation. It is only in zone 7 where significant bone atrophy can be observed, attributable to the damage that this area suffers during the surgical process and the subsequent stress-shielding caused by the implant design.

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Section: Discussionmentioning

confidence: 83%

Adaptive Bone Remodeling With New Design of the ABG Stem. Densitometric Study

López-Subías

Panisello

Mateo-Agudo

et al. 2019

Journal of Clinical Densitometry

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“…Of these studies, five trials 19 21 23 31 32 excluded participants who had a type C femur. Schilcher et al 31 found a significant effect of Dorr type on prostheses migration. More migration was observed in the CS group, particularly in type A femurs.…”

Section: Discussionmentioning

confidence: 97%

“…DEXA scans were performed within 3 days after surgery and 1 and 2 years postoperatively. Schilcher et al 31 reported the BMD values of G1, G5 and G7, and their results showed no significant difference between the two groups at 1 year and 2 years after surgery. However, G5 was created by the authors within G1, which was different from the original description of the zones.…”

Section: Outcomes Of the Meta-analysesmentioning

confidence: 97%

“…All results were stable except the BMD change in G7. At 2 years postoperatively, the difference between groups lost significance after one study was removed 20 ; additionally, although the removal of the data from another study 31 at 1 year and 2 years postoperatively reduced the I² to 0%, it also resulted in a significant difference between the groups. Thus, based on the results of our analysis, SS is equally effective for preserving proximal bone stock.…”

Section: Outcomes Of the Meta-analysesmentioning

confidence: 98%

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Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials

et al. 2018

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ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.MethodRelevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.ResultUltimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P<0.00001), and no differences were observed for the revision rate (relative risk (RR)=1.52; 95% CI, 0.71, 3.26; P=0.94), Harris Hip Score (MD=−0.38; 95% CI, −1.02, 0.26; P=0.89) or stem migration (MD=0.02; 95% CI, −0.07, 0.11; P=0.04).ConclusionOur results suggest that compared with CS, SS may provide superior bone remodelling and similar survival rates and clinical outcomes. However, the short-term follow-up of the included studies was inadequate to determine the long-term performance of SS.

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“…The conventional cemented hip stems most frequently used (Exeter, Lubinus, Charnley, Basis) have a length in the range of 115–170; longer versions can be as long as 260 mm . Shorter cemented stems are getting more interest because of the easier revision procedure, and better‐preserved bone stock in the case of loosening; furthermore, shorter stems allow smaller incisions and less invasive surgery . Limited clinical experience is currently available for shorter stems compared to the conventional longer ones.…”

mentioning

confidence: 99%

Standard and line‐to‐line cementation of a polished short hip stem: Long‐term in vitro implant stability

Morellato

Grupp

Bader³

et al. 2018

Journal Orthopaedic Research

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The current trend is toward shorter hip stems. While there is a general agreement on the need for a cement mantle thicker than 2 mm, some surgeons prefer line-to-line cementation, where the mantle has only the thickness provided by the cement-bone interdigitation. The aim of this study was to assess if a relatively short, polished hip stem designed for a standard cementation can also be cemented line-to-line without increasing the risk of long-term loosening. Composite femurs with specific open-cell foam to allow cement-bone interdigitation were used. A validated in-vitro biomechanical cyclic test replicating long-term physiological loading was applied to femurs where the same stem was implanted with the Standard-mantle (optimal stem size) and Line-to-line (same rasp, one-size larger stem). Implant-bone motions were measured during the test. Inducible micromotions never exceeded 10 μm for both implant types (differences statistically not-significant). Permanent migrations ranged 50-300 μm for both implant types (differences statistically not-significant). While in the standard-mantle specimens there was a pronounced trend toward stabilization, line-to-line had less tendency to stabilize. The cement cracks were observed after the test by means of dye penetrants: The line-to-line specimens included the same cracks of the standard-mantle (but in the line-to-line specimens they were longer), and some additional cracks. The micromotions and cement damage were consistent with those observed in-vitro and clinically for stable stems, confirming that none of the specimens became dramatically loose. However, it seems that for this relatively short polished stem, standard-mantle cementation is preferable, as it results in less micromotion and less cement cracking. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2736-2744, 2018.

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No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial

Cited by 30 publications

References 36 publications

Adaptive Bone Remodeling With New Design of the ABG Stem. Densitometric Study

Adaptive Bone Remodeling With New Design of the ABG Stem. Densitometric Study

Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials

Standard and line‐to‐line cementation of a polished short hip stem: Long‐term in vitro implant stability

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