Unstable versus stable uncemented femoral stems: a radiological study of periprosthetic bone changes in two types of uncemented stems with different concepts of fixation

Bodén, Henrik; Adolphson, Per; Öberg, Michael

doi:10.1007/s00402-004-0666-5

Cited by 29 publications

(15 citation statements)

References 59 publications

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“…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]. The importance of the early (1-2 years) bone resorption that we and others have found around fixed stems is not known.…”

Section: Bone-mineral Densitymentioning

confidence: 80%

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 Densitymentioning

confidence: 80%

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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“…Previous reports of the cementless proximally HA-coated Bi-Metric stems have found a similar pattern of bone reduction in the proximal region of Gruen zone 7 (Boden et al. 2004, 2006, Skoldenberg et al. 2006).…”

Section: Discussionmentioning

confidence: 99%

“…But even though the proximal periprosthetic BMD is reduced to a large extent in patients with Bi-Metric stems, it has been reported that stable Bi-Metric stems commonly have a proximal bone reduction whereas unstable Bi-Metric stems usually have a bone reduction along the entire stem (Boden et al. 2004). …”

Section: Discussionmentioning

confidence: 99%

Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

et al. 2016

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Background and purpose — Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone.Patients and methods — 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36–70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0–9.5) years after surgery.Results — Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03–0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0–9.5) years after surgery.Interpretation — Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.

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“…Another study showed a statistically significantly lower Harris Hip score and a more intense bone remodeling when measuring bone mineral density using a DEXA scan in the patients with a low-modulus stem compared to the situation with a high-modulus variant. The authors concluded that there was a less favorable host-bone response after long-term observation in 20 patients after 8 years (Bodén et al 2004). …”

Section: Discussionmentioning

confidence: 99%

Long-term results of a soft interface- (Proplast-) coated femoral stem

et al. 2006

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Background Mid-term clinical results of uncemented femoral components with a Proplast coating have been unfavorable and the low modulus system was abandoned in the mid-1990s. There are, however, still substantial numbers of patients with a Proplast-coated prosthesis in situ. We evaluated the clinical and radiographic results in patients with 8-13 year follow-up.Methods We evaluated the survival rate, Harris Hip score and radiographic features of 82 hips in 69 patients. Mean age at operation was 58 (35-72) years.Results With respect to the Harris Hip score (HHS), 21% of the hips were considered to be clinical failures (HHS < 70) at final follow-up, mainly because of excessive thigh pain. Osteolysis was observed in one or more Gruen zones in one-third of the hips. According to the criteria of Engh, 79/82 stems were unstable. 11 hips were eventually revised due to aseptic loosening. Survival of the femoral component of the original cohort at final follow-up was 84% (95% CI: 75-93) in a standard-case scenario.Interpretation Extensive signs of loosening were observed in almost all hips, while not all hips were considered to be clinical failures. Thus, all patients should be thoroughly screened for radiographic progressive osteolysis or the occurrence of thigh pain. Thigh pain or progressive osteolysis warrants revision of the Proplastcoated femoral stem.

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Unstable versus stable uncemented femoral stems: a radiological study of periprosthetic bone changes in two types of uncemented stems with different concepts of fixation

Cited by 29 publications

References 59 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

Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

Long-term results of a soft interface- (Proplast-) coated femoral stem

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