Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement

Gillies, Robin R.; Kohan, Lawrence; Cordingley, Rebecca

doi:10.1080/10255840601003577

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…In line with other study groups we found typical remodelling patterns with relative loss of bone in the region of the proximal femur and cortical hypertrophy at the distal stem. This basic pattern of bone remodelling seems to be largely regulated by the load distribution which is determined by design and stiffness of the stem [10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis

Briem¹,

Schneider²,

Bogner³

et al. 2010

International Orthopaedics (SICOT)

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Short stem prostheses that preserve the femoral neck are becoming more and more popular. The CFP (collum femoris preserving) has been introduced especially for the treatment of younger patients. However, information about remodelling, complications and learning curve are thus far rare. We present a retrospective study of 155 patients (average age 59.3±9.9 years) who underwent total hip replacement with the CFP prosthesis. Follow-up was obtained 74.3±9.4 months postoperatively. The Harris hip score revealed excellent and good results in 96%. One stem had to be exchanged due to aseptic loosening revealing a survival rate of 99% and 100% for stem and cup, respectively. Radiological analysis showed typical patterns of remodelling with apearance of cortical thickening predominantly in the distal part of the prosthesis. Implant related revision rate was <1%, with further complication rate independent of the surgeon's individual experience. With regard to outcome, survivorship and complication rate, the medium-term results of the CFP prosthesis are promising.

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Section: Discussionmentioning

confidence: 99%

Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis

Briem¹,

Schneider²,

Bogner³

et al. 2010

International Orthopaedics (SICOT)

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“…Clinical and radiographic results published by the developer of the implant suggested good clinical performance of this stem, but significant loss to follow-up and the absence of precise measurement of implant migration and periprosthetic BMD call these reports into question. Recent studies have found BMD reduction in the proximal femur around the CFP stem (Gillies et al 2007, Kress et al 2012). However, this bone loss does not appear to influence clinical outcome in the medium term (Gill et al 2008, Nowak et al 2011).…”

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confidence: 99%

A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA

Lazarinis¹,

Mattsson²,

Milbrink³

et al. 2013

Acta Orthopaedica

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Background and purpose Short femoral stems have been introduced in total hip arthroplasty in order to save proximal bone stock. We hypothesized that a short stem preserves periprosthetic bone mineral density (BMD) and provides good primary stability.Methods We carried out a prospective cohort study of 30 patients receiving the collum femoris-preserving (CFP) stem. Preoperative total hip BMD and postoperative periprosthetic BMD in Gruen zones 1–7 were investigated by dual-energy x-ray absorptiometry (DXA), stem migration was analyzed by radiostereometric analysis (RSA), and the Harris hip score (HHS) was determined.Results 2 patients were excluded intraoperatively and 1 patient was revised due to a deep infection, leaving 27 patients for analysis. The mean HHS increased from 49 (24–79) preoperatively to 99 (92–100) after 2 years. DXA after 1 year showed substantial loss of BMD in Gruen zone 7 (–31%), zone 6 (–19%), and zone 2 (–13%, p < 0.001) compared to baseline BMD determined immediately postoperatively. The bone loss in these regions did not recover after 2 years, whereas the more moderate bone loss in Gruen zones 1, 3, and 5 partially recovered. There was a correlation between low preoperative total hip BMD and a higher amount of bone loss in Gruen zones 2, 6 and 7. RSA showed minor micromotion of the stem: mean subsidence was 0.13 (95% CI: –0.28 to 0.01) mm and mean rotation around the longitudinal axis was 0.01º (95% CI: –0.1 to 0.39) after 2 years.Interpretation We conclude that substantial loss in proximal periprosthetic BMD cannot be prevented by the use of a novel type of short, curved stem, and forces appear to be transmitted distally. However, the stems showed very small migration—a characteristic of stable uncemented implants.

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“…Authors conclude that substantial loss in proximal periprosthetic BMD cannot be prevent by the use of CFP® stem, and forces appear to be transmitted distally (26). Other study have found similar pattern of BMD reduction in the proximal femur around the CFP stem (27,28). However this bone loss does not appear to influence clinical outcome in the medium term (29,30).…”

Section: Short Stemsmentioning

confidence: 53%

Densitometric evaluation of periprosthetic bone remodeling

Parchi¹

2014

ccmbm

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The application of Dual-energy X-ray absorptiometry (DEXA) in orthopaedic surgery gradually has been extended from the study of osteoporosis to different areas of interest like the study of the relation between bone and prosthetic implants. Aim of this review is to analyze changes that occur in periprosthetic bone after the implantation of a total hip arthroplasty (THA) or a total knee arthroplasty (TKA). In THA the pattern of adaptive bone remodeling with different cementless femoral stems varies and it appears to be strictly related to the design and more specifically to where the femoral stem is fixed on bone. Short stems with metaphyseal fixation allow the maintenance of a more physiologic load transfer to the proximal femur decreasing the entity of bone loss. Femoral bone loss after TKA seems to be related to the stress shielding induced by the implants while tibial bone remodeling seems to be related to postoperative changes in knee alignment (varus/valgus) and consequently in tibial load transfer. After both THA and TKA stress shielding seems to be an inevitable phenomenon that occurs mainly in the first year after surgery.KEY WORDS: dual-energy X-ray absorptiometry; adaptive bone remodeling; total hip arthroplasty; total knee arthroplasty.Stem. Remodeling patterns around a femoral stem are affected by several factors. These include patient-related factors, such as gender, age, initial femoral bone stock, patient activity, and underlying-disease as well as prosthesis-related factors, such as the type of fixation, stem length, stiffness, design, the extent of the coating area, and the method of

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Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement

Cited by 14 publications

References 34 publications

Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis

Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis

A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA

Densitometric evaluation of periprosthetic bone remodeling

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