Quantifying bone loss from the proximal femur after total hip arthroplasty

Abstract

To define the natural history of bone loss around a femoral prosthesis, the bone mineral content and bone mineral density were measured for each femur in 28 patients with unilateral total hip arthroplasty, 18 age-matched controls, and seven patients with unilateral osteoarthritis. The areas measured were inside the lesser trochanter and 4.8 cm distal to it. The contralateral hip served as the control. Three years after arthroplasty there was 40% loss in average bone mineral content inside the lesser trochanter, and 28% loss in average bone mineral content 4.8 cm distally in the medial cortex. At seven to 14 years after operation, patients had lost 40% of bone proximally and 49% distally. The data suggest that this may progress in a proximal-to-distal fashion, and could account for a 50% decrease in bone mass seven to 14 years after surgery.

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

“…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.…”

“…It might be that the elasticity of the prosthesis is more important for the proximal bone resorption than an optimal proximal press fit. We made no attempt to exclude the cement mantle from the analysis (of the Elite Plus stems) as we, like others [11,26], have found this to be more or less impossible. Wilkinson showed that excluding the cement mantle gives poorer precision, and that including the cement in the analysis resulted in a 20% increase of BMD [33].…”

Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial

“…Numerous authors have commented on the need for, and the value of, a more accurate measure of periprosthetic bone density (PBD) [5,14,29,31]. At the time of the study's inception, the use of DEXA scans to evaluate PBD was a relatively recent application allowing for more accurate and precise measurements of PBD [13,20,24,35,36].…”

Stress shielding: avaliação radiográfica após seguimento a longo prazo

“…Quando começaram a emergir os problemas relacionados ao cimento ósseo, a chamada "doença do cimento", foram realizados estudos considerando a eliminação do cimento, visando fixação biológica para o componente, advindo, dessa maneira, as próteses totais de quadril não cimentadas (9)(10)(11) . A maior parte desses estudos envolvia o intracrescimento ósseo em superfícies metálicas porosas.…”

“…Muitos autores têm discutido a teoria, mecanismos físicos e bioló-gicos, fatores de risco, identificação e medição da reabsorção óssea (7)(8)(9)(10)(11) . As preocupações relativas à reabsorção óssea incluem a perda de suporte mecânico e/ou do estoque ósseo, migração do implante e quebra da prótese e/ou do osso.…”