Skip to main content

Advertisement

SpringerLink
Log in

Pattern of Periprosthetic Bone Remodeling Around Stable Uncemented Tapered Hip Stems: A prospective 84-month follow-up study and a Median 156-month Cross-Sectional Study with DXA

  • Clinical Investigations
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

Bone resorption in the proximal femur is commonly seen after total hip arthroplasty (THA). With dual energy X-ray absorptiometry (DXA), the amount of bone mass (BMD) after implantation of a total hip stem can be precisely determined. However, prospective evaluation of the change of bone mass around the stem is only available for selected stems and short-term follow-up (up to 36 months). We analyzed BMD in patients who had undergone uncemented THA by DXA. Only patients with good clinical outcome (Merle d’ Aubigné score > 12) were included to obtain normative data for regular bone response. Two separate studies were performed: a prospective longitudinal study over 84 months with baseline values acquired within the first postoperative week (group A) (n = 26 patients) and a separate cross-sectional study, median follow-up 156 (124-178) months (group B) (n = 35 patients). Regions of interest were defined according to Gruen (ROI 1-7) and as net average ROI (net avg) for the periprosthetic femoral bone. After the initial remodeling process (12 months), BMD was compared to the 84-month (longitudinal) and the 156-month (cross-sectional) follow-up values to determine long-term periprosthetic changes of bone mineral density. The longitudinal study (group A), after the initial bone remodeling, showed no relevant further bone loss for women and men with BMD values 1.19 ± 0.15 and 1.40 ± 0.19, respectively, 12 months (women 89.8%, men 93.6%), and 1.19 ± 0.13 and 1.36 ± 0.18, respectively, after 84 months (women 90.0%, men 91.3%) (P = 0.98, P = 0.08,) respectively. The distribution of the BMD around the stem changed during the first 12 months. The ROIs around the proximal stem (ROI 1 and 7) showed the lowest absolute values at the 12-month follow-up and BMD in ROI 7 decreased most during the further follow-up until 84 months. The cross-sectional study (group B) showed no significant difference in BMD (net avg) values at a median of 156 months follow-up compared to the 12-month values (group A) (women: P = 0.77, men: P = 0.44). Initial BMD, implant diameter, and body mass index did not influence BMD loss (net avg) in this study, whereas age showed a weak correlation with BMD loss. The results show that after the initial remodeling process, no relevant further bone loss (net avg) occurs up to 84 months postsurgery, and values after a median of 156 months are similar. Normative long-term changes in the periprosthetic bone can be demonstrated in defined ROIs after implantation of a tapered corundum-blasted titanium stem with a good clinical result.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

References

  1. KC Ang S Das De JC Goh SL Low K Bose (1997) ArticleTitlePeriprosthetic bone remodelling after cementless total hip replacement. A prospective comparison of two different implant designs. J Bone Joint Surg Br 79 675–679 Occurrence Handle10.1302/0301-620X.79B4.7410 Occurrence Handle1:STN:280:ByiA1M3lsFQ%3D Occurrence Handle9250764

    Article  CAS  PubMed  Google Scholar 

  2. BJ Kiratli JP Heiner AA McBeath MA Wilson (1992) ArticleTitleDetermination of bone mineral density by dual x-ray absorptiometry in patients with uncemented total hip arthroplasty. J Orthop Res 10 836–844 Occurrence Handle1:STN:280:ByyD3Mbns1A%3D Occurrence Handle1403298

    CAS  PubMed  Google Scholar 

  3. BJ Kiratli MM Checovich AA McBeath MA Wilson JP Heiner (1996) ArticleTitleMeasurement of bone mineral density by dual-energy x-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem. J Arthroplasty 11 184–193 Occurrence Handle8648314

    PubMed  Google Scholar 

  4. D Sabo A Reiter HG Simank M Thomsen M Lukoschek V Ewerbeck (1998) ArticleTitlePeriprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium-threaded acetabular cup and cementless Spotorno stem with DEXA. Calcif Tissue Int 62 177–182 Occurrence Handle10.1007/s002239900413 Occurrence Handle1:CAS:528:DyaK1cXnslGmsQ%3D%3D Occurrence Handle9437053

    Article  CAS  PubMed  Google Scholar 

  5. C Trevisan M Bigoni G Randelli EC Marinoni G Peretti S Ortolani (1997) ArticleTitlePeriprosthetic bone density around fully hydroxyapatite coated femoral stem. Clin Orthop 340 109–117

    Google Scholar 

  6. PK Venesmaa HP Kroger HJ Miettinen JS Jurvelin OT Suomalainen EM Alhava (2001) ArticleTitleMonitoring of periprosthetic BMD after uncemented total hip arthroplasty with dual-energy X-ray absorptiometry — a 3-year follow-up study. J Bone Miner Res 16 1056–1061 Occurrence Handle1:STN:280:DC%2BD38%2FhtFKkug%3D%3D Occurrence Handle11393782

    CAS  PubMed  Google Scholar 

  7. K Yamaguchi K Masuhara K Ohzono N Sugano T Nishii T Ochi (2000) ArticleTitleEvaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. The influence of the extent of porous coating. J Bone Joint Surg Am 82-A 1426–1431 Occurrence Handle1:STN:280:DC%2BD3crgsFyjug%3D%3D Occurrence Handle11057471

    CAS  PubMed  Google Scholar 

  8. WH Harris (1995) ArticleTitleThe problem is osteolysis. Clin Orthop 311 46–53 Occurrence Handle7634590

    PubMed  Google Scholar 

  9. JD West MB Mayor JP Collier (1987) ArticleTitlePotential errors inherent in quantitative densitometric analysis of orthopaedic radiographs. A study after total hip arthroplasty. J Bone Joint Surg Am 69 58–64 Occurrence Handle1:STN:280:BiiC3cbjslc%3D Occurrence Handle3805071

    CAS  PubMed  Google Scholar 

  10. B Cohen N Rushton (1995) ArticleTitleAccuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg Br 77 479–483 Occurrence Handle1:STN:280:ByqB28zmsVM%3D Occurrence Handle7744941

    CAS  PubMed  Google Scholar 

  11. H Kroger H Miettinen I Arnala E Koski N Rushton O Suomalainen (1996) ArticleTitleEvaluation of periprosthetic bone using dual-energy x-ray absorptiometry: precision of the method and effect of operation on bone mineral density. J Bone Miner Res 11 1526–1530 Occurrence Handle1:STN:280:ByiD2cvnvVY%3D Occurrence Handle8889853

    CAS  PubMed  Google Scholar 

  12. WA Kalender (1992) ArticleTitleEffective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 2 82–87 Occurrence Handle1:STN:280:By2C28zmvVU%3D Occurrence Handle1536984

    CAS  PubMed  Google Scholar 

  13. HC Cattermole JL Cunningham (1995) ArticleTitleInfluence of metallic implants adjacent to the measurement site on DEXA measurements: a phantom study. Phys Med Biol 40 1885–1896 Occurrence Handle10.1088/0031-9155/40/11/008 Occurrence Handle1:STN:280:BymC283ns1A%3D Occurrence Handle8587938

    Article  CAS  PubMed  Google Scholar 

  14. JJ Callaghan SH Dysart CF Savory WJ Hopkinson (1990) ArticleTitleAssessing the results of hip replacement. A comparison of five different rating systems. J Bone Joint Surg Br 72 1008–1009 Occurrence Handle1:STN:280:By6D28%2Fmtlc%3D Occurrence Handle2246281

    CAS  PubMed  Google Scholar 

  15. L Spotorno S Romagnoli N Ivaldo G Grappiolo E Bibbiani DJ Blaha TA Guen (1993) ArticleTitleThe CLS system. Theoretical concept and results. Acta Orthop Belg 59 IssueIDsuppl 1 144–148 Occurrence Handle8116390

    PubMed  Google Scholar 

  16. ES Mortimer L Rosenthall I Paterson JD Bobyn (1996) ArticleTitleEffect of rotation on periprosthetic bone mineral measurements in a hip phantom. Clin Orthop 324 269–274 Occurrence Handle8595767

    PubMed  Google Scholar 

  17. TA Gruen GM McNeice HC Amstutz (1979) ArticleTitle“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141 17–27 Occurrence Handle477100

    PubMed  Google Scholar 

  18. CA Engh JD Bobyn (1988) ArticleTitleThe influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop 231 7–28

    Google Scholar 

  19. HG Simank DR Brocai D Reiser M Thomsen D Sabo M Lukoschek (1997) ArticleTitleMiddle-term results of threaded acetabular cups. High failure rates five years after surgery. J Bone Joint Surg Br 79 366–370 Occurrence Handle10.1302/0301-620X.79B3.7273 Occurrence Handle1:STN:280:ByiA38vhsVU%3D Occurrence Handle9180310

    Article  CAS  PubMed  Google Scholar 

  20. H Kroger E Vanninen M Overmyer H Miettinen N Rushton O Suomalainen (1997) ArticleTitlePeriprosthetic bone loss and regional bone turnover in uncemented total hip arthroplasty: a prospective study using high resolution single photon emission tomography and dual-energy X-ray absorptiometry. J Bone Miner Res 12 487–492 Occurrence Handle1:STN:280:ByiB3s7hvFw%3D Occurrence Handle9076593

    CAS  PubMed  Google Scholar 

  21. R Siebold G Scheller U Schreiner L Jani (2001) ArticleTitleLong-term results with the cement-free Spotorno CLS shaft. Orthopade 30 317–322 Occurrence Handle10.1007/s001320050614 Occurrence Handle1:STN:280:DC%2BD3Mzls1Glug%3D%3D Occurrence Handle11417240

    Article  CAS  PubMed  Google Scholar 

  22. PR Aldinger SJ Breusch M Lukoschek H Mau V Ewerbeck M Thomsen (2003) ArticleTitle10-15 year follow-up of the cementless Spotorno stem. J Bone Joint Surg Br 85 B

    Google Scholar 

  23. O Lofman L Larsson I Ross G Toss K Berglund (1997) ArticleTitleBone mineral density in normal Swedish women. Bone 20 167–174 Occurrence Handle9028542

    PubMed  Google Scholar 

  24. DJ Kilgus EE Shimaoka JS Tipton RW Eberle (1993) ArticleTitleDual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg Br 75 279–287 Occurrence Handle1:STN:280:ByyC1cnovFI%3D Occurrence Handle8444950

    CAS  PubMed  Google Scholar 

  25. CK McCarthy GG Steinberg M Agren D Leahey E Wyman DT Baran (1991) ArticleTitleQuantifying bone loss from the proximal femur after total hip arthroplasty. J Bone Joint Surg Br 73 774–778 Occurrence Handle1:STN:280:By6A2szkt1Q%3D Occurrence Handle1894664

    CAS  PubMed  Google Scholar 

  26. AS Carlsson CF Gentz L Linder (1983) ArticleTitleLocalized bone resorption in the femur in mechanical failure of cemented total hip arthroplasties. Acta Orthop Scand 54 396–402 Occurrence Handle1:STN:280:BiyB38jgvFw%3D Occurrence Handle6858658

    CAS  PubMed  Google Scholar 

  27. MC Nevitt NE Lane JC Scott MC Hochberg AR Pressman HK Genant SR Cummings (1995) ArticleTitleRadiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum 38 907–916 Occurrence Handle1:STN:280:ByqA3snkvVA%3D Occurrence Handle7612040

    CAS  PubMed  Google Scholar 

  28. M Doblare JM Garcia (2001) ArticleTitleApplication of an anisotropic bone-remodelling model based on a damage-repair theory to the analysis of the proximal femur before and after total hip replacement. J Biomech 34 1157–1170 Occurrence Handle10.1016/S0021-9290(01)00069-0 Occurrence Handle1:STN:280:DC%2BD3Mvmt1eqsA%3D%3D Occurrence Handle11506786

    Article  CAS  PubMed  Google Scholar 

  29. R Huiskes (1990) ArticleTitleThe various stress patterns of press-fit, ingrown, and cemented femoral stems. Clin Orthop 261 27–38 Occurrence Handle2245558

    PubMed  Google Scholar 

  30. R Huiskes H Weinans HJ Grootenboer M Dalstra B Fudala TJ Slooff (1987) ArticleTitleAdaptive bone-remodeling theory applied to prosthetic-design analysis. J Biomech 20 1135–1150 Occurrence Handle1:STN:280:BieC3Mrkt1E%3D Occurrence Handle3429459

    CAS  PubMed  Google Scholar 

  31. J Kerner R Huiskes GH van Lenthe H Weinans B van Rietbergen CA Engh AA Amis (1999) ArticleTitleCorrelation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling. J Biomech 32 695–703 Occurrence Handle10.1016/S0021-9290(99)00041-X Occurrence Handle1:STN:280:DyaK1MzisF2ntg%3D%3D Occurrence Handle10400357

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dorothea Rösch, radiographic technician, for conducting the DXA measurements. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Author information

Authors and Affiliations

  1. Stiftung Orthopädische Universitätsklinik Heidelberg, University of Heidelberg, Germany

    P. R. Aldinger, D. Sabo, M. Thomsen, H. Mau, V. Ewerbeck & S. J. Breusch

  2. Institute for Medical Biometry and Informatics, University of Heidelberg, Germany

    M. Pritsch

Authors
  1. P. R. Aldinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Sabo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Pritsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Thomsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Mau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Ewerbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. J. Breusch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. J. Breusch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aldinger, P., Sabo, D., Pritsch, M. et al. Pattern of Periprosthetic Bone Remodeling Around Stable Uncemented Tapered Hip Stems: A prospective 84-month follow-up study and a Median 156-month Cross-Sectional Study with DXA . Calcif Tissue Int 73, 115–121 (2003). https://doi.org/10.1007/s00223-002-2036-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-002-2036-z

Keywords

Search

Navigation