Bone Remodeling Characteristics of a Short-Stemmed Total Hip Replacement

doi:10.1016/j.arth.2008.07.014

The Journal of Arthroplasty

Volume 24, Issue 6, September 2009, Pages 945-950

https://doi.org/10.1016/j.arth.2008.07.014 Get rights and content

Abstract

Bone remodeling of a metaphyseal fixed femoral stem, Mayo Conservative Hip (Zimmer International, Warsaw, Ind), was characterized by the dual-energy x-ray absorptiometry and a mathematical remodeling model. The mean age of the patient was 50.8 years, and the mean follow-up was 5.7 years. As anticipated, bony structure underwent significant remodeling after the short-stemmed femoral arthroplasty with resorption proximally and ingrowth distally/laterally. Theoretical prediction further suggested that the remodeling was largely regulated by the mechanical loading distribution pattern determined by implant design.

Section snippets

Materials and Methods

The study included 29 patients undergoing the total hip replacement using the Mayo Conservative Hip between 1991 and 2001 with approval by the ethics committee of Mayo Clinic (Rochester, Minn). The patients were selected to provide a spectrum of ages and especially surveillance. All were of an age of less than 75 years, with adequate quality of bone as determined by rigid fixation of the rasp and a body weight of less than 90 kg. There were 15 females with a mean of 48.6 years (range, 19-68

Results

Dual-energy x-ray absorptiometry demonstrated that the range of BMD value among all the individuals after THA was from 0.29 to 3.28 g/cm² (mean, 1.48 ± 0.28 g/cm²) (Fig. 1). The lowest density was found in zone 1 (0.78 ± 0.17 g/cm²), and the highest was in zone 3 (2.18 ± 0.33 g/cm²) (Fig. 2).

Compared to the contralateral side, changes in BMD were found in most zones (Fig. 2). Significant decrease was found proximally in zone 1 (14.4%, P < .0001), zone 6 (14.4%, P < .0001), and zone 7 (17.9%, P

Discussion

It has been suggested that the use of a short-stemmed femoral component could conserve proximal bone and to achieve more proximal load transfer into the femur to reduce proximal stress shielding [4], a phenomenon that has been associated with bone resorption around traditional stems [18], which can lead to implant loosening [19]. This study provided quantitative DEXA and BMD analysis to examine the remodeling features of the short-stemmed femoral component. Our results demonstrate resorption in

Acknowledgments

We acknowledge with gratitude the efforts of Bob Adams for patient scheduling and assessment.

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Assigning trabecular bone material properties in finite element models simulating the pelvis before and after the development of peri-prosthetic osteolytic lesions
2022, Journal of the Mechanical Behavior of Biomedical Materials
Estimating strain distribution in the acetabulum before and after the development of peri-prosthetic osteolytic lesions secondary to total hip arthroplasty may assist with understanding the pathogenesis of this condition. This could be achieved by performing patient-specific finite element analysis of (1) total hip arthroplasty recipients with developed acetabular osteolytic lesions, and (2) models simulating the patient's pelvis and implant immediately after primary surgery. State of the art patient-specific total hip arthroplasty finite element analysis simulations obtain trabecular bone material properties from Hounsfield units within computed tomography (CT) scans of patients. However, this is not feasible when an implant is already in situ due to metal artefact disruption and, in turn, incorrectly reproduced Hounsfield units. Therefore, alternative methods of assigning trabecular bone material properties within such models were tested and strain results compared. It was found that assigning set material properties throughout the trabecular bone geometry was sufficient for the desired application. Simulating the primary implant and pelvis requires geometric and material based assumptions. Therefore, comparisons were made between strain values obtained from simulated primary models, from state of the art methods using material properties obtained from intact bone within a CT scan, and from models with osteolytic lesions. Strain values found using the finite element models simulating the pelvis before osteolytic lesion developed were considerably closer to those found using state of the art methods than those found for the bone loss models. These models could be used to determine relationships between strain distribution and factors such as bone loss.
Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?
2022, Journal of Arthroplasty
Short cementless femoral stems may allow for easier insertion with less dissection. The use of short stems with the anterior approach (AA) may be associated with a considerable perioperative fracture risk. Our aim was to evaluate whether patient-specific femoral and pelvic morphology and surgical technique, influence the perioperative fracture risk. Furthermore, we sought to describe important anatomical thresholds alerting surgeons.
A single-center, multi-surgeon retrospective, case-control matched study was performed. Thirty nine periprosthetic fractures (3.4%) in 1,145 primary AA THAs using short cementless stems were identified. These were matched with 78 THA nonfracture controls for factors known to increase the fracture risk. A radiographic analysis using validated software measured femoral (canal flare index [CFI], morphological cortical index [MCI], and calcar-calcar ratio [CCR]) and pelvic (Ilium-ischial ratio [IIR], ilium overhang, and anterior superior iliac spine [ASIS] to greater trochanter distance) morphologies and surgical techniques (% canal fill). A multivariate and Receiver-Operator Curve (ROC) analysis was used to identify fracture predictors.
CFI (3.7 ± 0.6 vs 2.9 ± 0.4, P < .001) and CCR (0.5 ± 0.1 vs 0.4 ± 0.1, P = .006) differed. The mean IIR was higher in fracture cases (3.3 ± 0.6 vs 3.0 ± 0.5, P < .001). Percent canal fill was reduced in fracture cases (82.8 ± 7.6 vs 86.7 ± 6.8, P = .007). Multivariate and ROC analyses revealed a threshold CFI of 3.17 which was predictive of fracture (sensitivity: 84.6%/specificity: 75.6%). The fracture risk was 29 times higher when patients had CFI >3.17 and II ratio >3 (OR: 29.2 95% CI: 9.5-89.9, P < .001).
Patient-specific anatomical parameters are important predictors of a fracture-risk. A careful radiographic analysis would help identify those at a risk of early fracture using short stems, and alternative stem options should be considered.
Survivorship and Outcomes of Femoral Neck Preserving Stems in Primary Total Hip Arthroplasty
2022, Journal of Arthroplasty
Short-stem femoral implants (SSFIs) promote the preservation of bone in the femoral neck, reduce soft tissue disruption, and facilitate minimally invasive surgical techniques. The purpose of this study was to report the revision rate, complication rate, patient satisfaction, patient-reported outcomes, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) with the Alteon Neck Preserving Femoral Stem (ANPS).
A prospectively maintained database was reviewed which analyzed 92 THAs between the years 2016 and 2018. Patient-reported outcomes, patient satisfaction, complication rates, and radiographic outcomes were assessed at 2-5 years postoperatively.
The final cohort consisted of 63 hips. Five patients (7.9%) underwent revision surgery and 2 (3.2%) had other complications not requiring revision. Survivorship when considering only the femoral component was 93.7% at an average of 41.4 months of follow-up. The average postoperative Oxford Hip Score (41.5 ± 8.3) and Harris Hip Score (77.9 ± 16.6) demonstrated significant improvement among our nonrevised patients, respectively (P < .001). Radiographs demonstrated spot welding in 56% of arthroplasties most commonly in Gruen Zones 2, 3, and 13 and that femur radiolucencies were visualized in 58% predominantly along the distal aspect of the stem. Radiographic femoral component subsidence was present in 9.7% of patients.
The ANPS may be less reliable than previously reported. Our cohort’s revision rate was unacceptably high with 6.3% requiring revision surgery for femoral component loosening in less than 5 years. Surgeons should consider the challenges and prohibitive failure rate associated with SSFIs before routine usage in THA.
Bone Preservation in Total Hip Arthroplasty
2022, Journal of Arthroplasty
Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up.
This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded.
At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported.
Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.
Comparison of periprosthetic bone mineral density between two types of short-stems in total hip arthroplasty with a mean follow-up of 4 years
2022, Revue de Chirurgie Orthopedique et Traumatologique
L’utilisation de pivots courts en arthroplastie primaire de hanche a considérablement augmenté ces dernières années, avec une grande variété de dessin et de mode de stabilisation. L’influence du dessin et du mode de fixation a été peu évaluée, notamment dans le cadre d’étude comparatives, pour le rôle qu’elle peut avoir sur la densité minérale osseuse sensée être mieux préservée avec les implants courts. Aussi nous avons mené une étude comparative rétrospective à moyen terme afin de : (1) préciser l’influence du dessin de deux types de pivots courts la densitométrie osseuse péri-prothétique ; (2) comparer leurs résultats radio-cliniques.
La densitométrie osseuse péri-prothétique d’un pivot court varie en fonction du dessin de la prothèse.
Quatre-vingt-treize patients ont bénéficié d’une prothèse totale de hanche (PTH) à pivot court entre juillet 2012 et juillet 2014. Deux groupes de patients ont été constitués pour recevoir soit le pivot court Vitae™ (Adler Ortho, Milan, France), soit le pivot court Optimys™ (Mathys, Bettlach, Suisse). Le groupe Vitae comprenait 46 patients, le groupe Optimys comprenait 47 patients. L’âge moyen était de 66 ans et l’indice de masse corporelle (IMC) moyen était de 26 kg/m². Les groupes étaient comparables pour l’âge, l’IMC, le sexe, le score de Harris et les indices radiologiques préopératoires. La densitométrie osseuse péri-prothétique des 2 types de prothèse a été étudiée entre la première et la quatrième année postopératoire grâce à une analyse densitométrique par absorptiométrie de rayons X à double énergie (DEXA) selon les zones de Gruen. Les résultats radio + cliniques ont également été recueillis.
Il existait une diminution significative de la densité minérale osseuse (DMO) en zone 7 (−5,8 % ± 0,1 IC_95 %[−0,09 ; −0,02] (p = 0,003)), en zone 2 (−4,8 % ± 0,1 IC_95 %[−0,093 ; −0,003] (p = 0,038)) et en zone 6 (−11 % ± 0,2 IC_95 %[−0,19 ; −0,03] (p = 0,009)) concernant le Vitae et en zone 2 (−13,7 % ± 0,3 IC_95 %[−0,25 ; −0,03] (p = 0,018)) concernant le groupe Optimys. Une différence significative de DMO en zone 7 à 1 an (p = 0,014) et 4 ans (p = 0,001) postopératoires et en zone 6 (p = 0,011) uniquement à 4 ans postopératoires en faveur du groupe Optimys a été retrouvée lors de la comparaison intergroupe. Une augmentation significative de l’offset fémoral a été observée uniquement dans le groupe Optimys, respectivement Δoffset = −0,50 mm ± 5,2 IC_95 %[−2,05 ; 1,05] (p = 0,522) et Δoffset = 2,79 mm ± 4,2 IC_95 %[1,21 ; 4,37] (p = 0,001). Concernant le score de Harris, il n’y avait pas de différence significative entre les deux groupes à 4 ans (95,3 ± 2,5 [88 ; 99] vs 95,2 ± 2,6 [88 ; 99] (p = 0,991)).
Le dessin des pivots courts semble avoir une influence sur la répartition des charges et sur la densitométrie osseuse péri-prothétique. Celles-ci rapportent de très bons résultats radio-cliniques à moyen terme. Le remodelage osseux semble se poursuivre largement après un an de l’implantation de la PTH.
III ; étude rétrospective cas-témoin.
Comparison of periprosthetic bone mineral density between two types of short-stems in total hip arthroplasty with a mean follow-up of 4 years
2022, Orthopaedics and Traumatology: Surgery and Research
The use of short stems in primary hip arthroplasty has grown considerably in recent years, with a large variety of designs and stabilization methods available. Few studies have directly compared how these designs and fixation modes influence the bone mineral density (BMD) that is said to be better preserved with shorter implants. This led us to carry out a medium-term retrospective comparative study to (1) specify how the design of two different types of short stems influences the periprosthetic BMD, (2) compare the radiological and clinical outcomes of these stems.
The periprosthetic BMD of a short stem varies based on the implant's design.
Ninety-three patients underwent total hip arthroplasty (THA) with a short stem between July 2012 and July 2014. Two groups of patients were formed: Vitae™ short stem (Adler Ortho, Milan, France), Optimys™ short stem (Mathys, Bettlach, Switzerland). The Vitae group consisted of 46 patients, while the Optimys group consisted of 47 patients. The mean age was 66 years, and the mean body mass index (BMI) was 26 kg/m². The groups had comparable age, BMI, sex, Harris Hip score and preoperative radiological features. Periprosthetic BMD of the two types of implants was determined between the 1^st and 4th year postoperative using dual-energy x-ray absorptiometry (DEXA) in the Gruen zones. The radiological and clinical outcomes were also determined.
There was a significant decrease in BMD in zone 7(−5.8% ± 0.1 CI_95%[−0.09; −0.02] (p = 0.003)), zone 2 (−4.8% ±0.1 CI_95%[−0.093; −0.003] (p = 0.038)) and zone 6 (−11% ±0.2 CI_95%[−0.19; −0.03] (p = 0.009)) in the patients with Vitae stems and in zone 2 (−13.7% ± 0.3 CI_95%[−0.25; −0.03] (p = 0.018)) in the patients with Optimys stems. A significant difference in BMD in zone 7 at 1 year (p = 0.014) and 4 years (p = 0.001) postoperative and in zone 6 (p = 0.011) at 4 years postoperative existed between groups, with the Optimys group having higher BMD. There was a significant increase in femoral offset in the Optimys group but not the Vitae group: Δoffset=–0.50 mm ± 5.2 CI_95%[−2.05; 1.05] (p = 0.522) and Δoffset = 2.79 mm ± 4.2 CI_95%[1.21; 4.37] (p = 0.001). The Harris Hip score was not significantly different between the two groups at 4 years postoperative (95.3 ± 2.5 [88; 99] vs. 95.2 ± 2.6 [88; 99] (p = 0.991)).
The design of short stems appears to influence the distribution of loads and the periprosthetic BMD. These stems are associated with very good radiological and clinical results in the medium term. Bone remodeling appears to continue beyond 1 year after the THA procedure.
III; Retrospective case-control study.

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: These benefits or support were received from Zimmer Research Grant.

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Bone Remodeling Characteristics of a Short-Stemmed Total Hip Replacement

Abstract

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

J Arthroplasty

J Biomech

J Biomech

J Orthop Res

J Arthroplasty

Behavior of the femoral stem in the bihapro hip prosthesis

Orthopedics.

The thrust plate hip prosthesis

Design of the femoral component for cementless hip replacement: The surgeon's perspective

Am J Orthopedics

A consecutive femoral replacement for total hip arthroplasty

J Bone Joint Surg

Initial stability of a modular uncemented, porous-coated femoral stem: a mechanical study

Am J Orthopedics

Preservation of the femoral neck in hip arthroplasty: results of a 13 to 17 year follow-up

J Orthop Traumatol

Migration pattern of a short femoral neck preserving stem

Clin Orthop

The influence of design parameters on calcar stresses following femoral head arthroplasty

J Biomed Mater Res

Biomechanics of noncemented total hip arthroplasty

Curr Opin Orthop

“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening

Clin Orthop

Effects of mechanical stress/strain and estrogen on bony structure predicted by fuzzy decision

IEEE Trans Biomed Eng