Radiographic changes in bone dimensions in asymptomatic cemented total hip arthroplasties. Results of nine to thirteen-year follow-up.

Comadoll, James L; Sherman, Robert S.; Gustilo, Ramon B.; Bechtold, Joan E.

doi:10.2106/00004623-198870030-00017

Cited by 34 publications

(7 citation statements)

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“…4). Previous authors have also described the progressive nature of the cortical thinning and endosteal canal expansion observed in this study [6,10,17]. Newer cementless implants have also shown distal hypertrophy to be an early phenomenon and endosteal loss to be progressive [2].…”

Section: Discussionsupporting

confidence: 75%

“…Kwong et al [15] described that the radiolucency that appears radiographically between the bone-cement interface corresponds to an area of osteoporosis, cancellization, thinning of the endosteal cortex, and osteopenia of the trabecular bone but does not represent loosening of the prosthesis. Previous clinical studies on proximal femoral remodeling have focused on endosteal expansion and cortical thinning resulting from the perceived increased risk of aseptic loosening [6,10,17], whereas only one study has mentioned distal cortical hypertrophy since Charnley's original observation in 1968 [4,14]. In this study, Kobayashi et al [14] reviewed 326 Charnley femoral prostheses at a mean 13.3 years followup in an Asian population.…”

Section: Introductionmentioning

confidence: 93%

“…Previous studies have shown that normal proximal femoral remodeling is characterized by cortical thinning and subperiosteal endosteal expansion, which is more pronounced in females [7,18,20]. Comadoll et al [6] reported in 26 hips at a mean of 10.4-year followup decreased cortical thickness and widening of the medullary canal with no change in the total outer periosteal diameter. This increase in medullary canal diameter and associated thinning of the proximal femoral cortex are associated radiographically with the development of a radiolucent line.…”

Section: Introductionmentioning

confidence: 96%

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Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

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Callaghan

Klocke

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background There are two unusual remodeling patterns of the proximal femur around well-fixed Charnley total hip arthroplasties: cortical thinning leading to endosteal widening around the femoral component and hypertrophy of the distal femoral cortex. Previous studies have shown remodeling patterns are affected by stem design and occur early postoperatively. It is unclear if these changes are related to patient demographics or if they progress throughout the lifetime of the implant.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 96%

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Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Teusink

Callaghan

Klocke

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The transition between these two trends, at which the shear stresses were roughly independent of the stem modulus, generally occurred at the proximal diaphysis (section 8). At the most proximal section (section 14), the shear stresses were again positively related to the modulus of the stem, with the highest shear stresses predicted for the cobaltchromium prosthesis.…”

Section: Implant-bone Interface Shear Stressmentioning

confidence: 93%

Role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty

Cheal¹,

Spector²,

Hayes

1992

Journal Orthopaedic Research

191

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The objective of this study was to establish the role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty. We developed a three-dimensional finite element model of an intact human femur and the same femur with a conventional collared straight-stem femoral component. Using published data, we defined two sets of loading conditions: one that represented three phases of gait, and one that represented four different extreme loads. The four extreme loads were based on the peak joint contact forces that occur during stair ascent and isometric contraction of various muscle groups. The model was analyzed with three different material properties for the prosthesis, including cobalt-chromium alloy, titanium alloy, and a carbon fiber-reinforced polymer (CFRP) laminate. We assumed that the implant was stable, with rigid bonding, collar contact, and no cement. To address femoral component loosening, we examined the shear stresses at the implant-bone interface; to address adaptive bone remodeling, we examined the principal stresses in the supporting cortical bone relative to those in the intact femur. Our analyses of the various loading conditions demonstrated large out-of-plane bending movements and torsional moments, especially for the load representing stair ascent. Based on stepwise multiple regressions, the maximum shear stresses at the implant-bone interface in the distal region were dependent on the total applied axial force and torsion; the maximum shear stresses in the proximal region were dependent on the axial component of the joint contact force alone. Reduction in the prosthesis stiffness, by substitution of the CFRP material properties, resulted in lower interface shear stresses at the distal end of the stem and higher interface shear stresses at the more proximal sections, consistent with the findings of others. We fit equations, based on composite beam theory, to the maximum implant-bone interface shear stresses and the cortical bone principal stresses as a function of the axial modulus of the prosthesis. These equations can be used to estimate the maximum stresses at the interface and in the cortical bone that would be predicted by similar models, for the same prosthesis constructed of alternative materials, relative to the stresses in the intact femur. The nonlinear nature of these relationships was such that the cortical bone stresses changed more rapidly, as a function of the prosthesis modulus, for lower values of elastic modulus, especially in the more proximal sections.

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“…Much of the information as it relates to bone remodeling comes from clinical radiographic studies. [1][2][3] However, the three-dimensional (3D) geometry of the femur and the limitation of plain radiographs make it difficult to accurately assess quantitative bone remodeling. Dual energy X-ray absorptiometry has been proven to be accurate for the determination of periprosthetic bone mineral density, with an error below 1%.…”

Section: Introductionmentioning

confidence: 99%

Mechanical properties of femoral cortical bone following cemented hip replacement

Chiu

et al. 2007

Journal Orthopaedic Research

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Femoral bone remodeling following total hip replacement is a big concern and has never been examined mechanically. In this study, six goats underwent unilateral cemented hip hemiarthroplasty with polymethyl methacrylate (PMMA) bone cement. Nine months later animals were sacrificed, and the femoral cortical bone slices at different levels were analysed using microhardness testing and microcomputed tomography (micro-CT) scanning. Implanted femurs were compared to contralateral nonimplanted femurs. Extensive bone remodeling was demonstrated at both the proximal and middle levels, but not at the distal level. Compared with the nonimplanted side, significant decreases were found in the implanted femur in cortical bone area, bone mineral density, and cortical bone hardness at the proximal level, as well as in bone mineral density and bone hardness at the middle level. However, no significant difference was observed in either variable for the distal level. In addition, similar proximal-to-distal gradient changes were revealed both in cortical bone microhardness and bone mineral density. From the mechanical point of view, the results of the present study suggested that stress shielding is an important mechanical factor associated with bone adaptation following total hip replacement.

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Radiographic changes in bone dimensions in asymptomatic cemented total hip arthroplasties. Results of nine to thirteen-year follow-up.

Cited by 34 publications

References 0 publications

Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty

Mechanical properties of femoral cortical bone following cemented hip replacement

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