Stress-related femoral cortical and cancellous bone density loss after collum femoris preserving uncemented total hip arthroplasty: a prospective 7-year follow-up with quantitative computed tomography.

PURPOSE: Bone loss around uncemented femoral components is suspected to precede implant loosening and contribute to problems in revision surgery. Short-stemmed cementless femoral components are designed to preserve proximal femoral bone stock and ultimately the longevity of the prosthesis. METHODS: With quantitative computed tomography-assisted osteodensitometry, we prospectively analyzed femoral cortical and cancellous bone density (BD) and contact area changes of an uncemented collum femoris preserving stem (n = 38) 10 days, 1, 3 and 7 years post-operatively. RESULTS: Seven years post-operatively, cancellous BD (mg CaHA/mL) had decreased by as much as -66 % and cortical BD by up to -27 % at the metaphyseal portion of the femur; the decrease was progressive between the 1- and 3-year examinations and halted thereafter. Contact area (in % out of a possible 100 %) decreased proximally between the 1- and 3-year follow-up. CONCLUSION: Proximal cortical and cancellous bone density loss and decrease of contact area indicate that metaphyseal fixation cannot be achieved. The lack of cortical BD loss and increase of contact area values below the trochanter minor suggest diaphyseal fixation.

Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up.

Ceramic-on-ceramic coupling is thought to be a durable alternative to metal- or alumina-on-polyethylene pairing. No evidence exists suggesting superior clinical and radiological results for hydroxyapatite-coated stems versus uncoated stems. The aim of this study is to report the performance of an alumina-on-alumina bearing cementless total hip arthroplasty and to compare stems with a tapered design with and without hydroxyapatite coating. We prospectively analysed the results of cementless tapered femoral stems (40 hydroxyapatite-coated versus 22 uncoated stems), a metal-backed fibre mesh hydroxyapatite-coated socket and alumina-on-alumina pairing. Of 75 hips studied, 62 were available for follow-up (mean of 10.5 years after surgery). The average Harris hip score was 90. Only one hydroxyapatite-coated stem was revised for aseptic loosening. One instance of non-progressive osteolysis was detected around a screw of a cup. All other components showed radiographic signs of stable ingrowth. Hydroxyapatite coating of the stem had no significant impact on the clinical or radiological results. Total hip arthroplasty with the presented implant and pairing provides a durable standard for all patients requiring hip joint replacement against which all newer generations of cementless implants should be judged.

Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up.

AIM: Tissue sparing hip prostheses are becoming more and more popular especially for the treatment of younger patients. The objective of this study was to evaluate the clinical and radiological results after insertion of a tissue sparing hip prosthesis. METHOD: In 47 consecutive non-selected patients (50 hips), the clinical and radiographic results of cementless total hip arthroplasty using a collum femoris preserving stem, a pressfit cup and an alumina-polyethylene pairing were prospectively evaluated. The mean age at index-surgery was 58 (36-82) years, there were 38 women and 9 men. After a mean follow-up of 6.8 years (minimum 6.1 years), two patients had died and one patient underwent revision surgery due to aseptic loosening of the stem. RESULTS: The overall survival rate of the acetabular component was 100% and of the femoral component 98%. The mean Harris hip score at follow-up was 94 points. CONCLUSION: The mid-term survival with this type of total hip arthroplasty is excellent and compares equal with uncemented straight stems in this age group.

Progressive femoral cortical and cancellous bone density loss after uncemented tapered-design stem fixation.

BACKGROUND: Aseptic implant loosening and periprosthetic bone loss are major problems after total hip arthroplasty (THA). We present an in vivo method of computed tomography (CT) assisted osteodensitometry after THA that differentiates between cortical and cancellous bone density (BD) and area around the femoral component. METHOD: Cortical and cancellous periprosthetic femoral BD (mg CaHA/mL), area (mm(2)) and contact area between the prothesis and cortical bone were determined prospectively in 31 patients 10 days, 1 year, and 6 years after uncemented THA (mean age at implantation: 55 years) using CT-osteodensitometry. RESULTS: 6 years postoperatively, cancellous BD had decreased by as much as 41% and cortical BD by up to 27% at the metaphyseal portion of the femur; this decrease was progressive between the 1-year and 6-year examinations. Mild cortical hypertrophy was observed along the entire length of the diaphysis. No statistically significant changes in cortical BD were observed along the diaphysis of the stem. INTERPRETATION: Periprosthetic CT-assisted osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling. Continuous loss of cortical and cancellous BD at the femoral metaphysis, a homeostatic cortical strain configuration, and mild cortical hypertrophy along the diaphysis suggest a diaphyseal fixation of the implanted stem. CT-assisted osteodensitometry has the potential to become an effective instrument for quality control in THA by means of in vivo determination of periprosthetic BD, which may be a causal factor in implant loosening after THA.

[Dynamic analysis of olecranon osteosyntheses--an in vitro comparison of two osteosynthesis systems]. / Dynamische Analyse von Osteosynthesen am Olecranon: ein in-vitro Vergleich zweier Osteosynthesesysteme.

INTRODUCTION: The aim of the present study was to develop a test setup with continuous angle alteration to imitate elbow joint motion for the mechanical evaluation of tension band wiring and a newly designed intramedullary nail. MATERIALS AND METHODS: The servo-pneumatical test stand worked with a rotational angle-adjusted and a linear force-adjusted engine. The fracture model was dynamically tested under cyclic loading imitating elbow joint motion. In total, 14 fresh cadaver upper extremities underwent olecranon fracture by means of transverse osteotomy and were assigned to two groups: tension band wiring and intramedullary nailing. There was a continuous angle alteration between 0 and 1000 of flexion, with continuous changing pull force between 25 N and 150 N. Two steel pins were placed in the proximal, two in the distal olecranon fragment for video analysis of the motion between the two pairs of pins. Displacement in the fracture gap was determined after 4 and 300 cycles. RESULTS: After 300 cycles, the displacement in the fracture fixation model was significantly higher in the tension band wiring group than in the intramedullary nailing group. DISCUSSION: Other studies evaluating biomechanical properties of olecranon osteosyntheses with joint involvement did not change the force direction dynamically. We introduced a test setup with continuous angle alteration to imitate joint motion. This is an important step for accurate biomechanical evaluation of the treatment of different fixation methods in olecranon fractures. The tested nailing system showed significant advantages in loosening under cyclic loading compared to tension band wiring.

Radiostereometric migration measurement of an uncemented Cerafit® femoral stem: 26 patients followed for 10 years.

Radiostereometric analysis (RSA) is the gold standard for evaluating micromotions of orthopaedic implants. The method is applied for identifying novel design weaknesses in endoprostheses. Current research frequently assesses relatively short time periods. Short-term RSA studies have been widely used for predicting the long-term stability of many hip prosthetic designs, but only a few studies have focused on uncemented hip implants, especially for extended periods. The purpose of this study was to analyse the migration pattern of the Cerafit® femoral stem within 10 years and to verify the predictive value of short-term RSA after 2 years for this uncemented femoral hip stem. Twenty-six patients were followed for 10 years. Ten years after implantation, a mean subsidence of 0.22 mm±0.56 mm, a mean internal rotation of 0.59°±1.67° and a mean maximum total point motion (MTPM) of 1.28 mm±0.54 mm were detected. The main migration took place in the first 6 weeks after surgery (subsidence of 0.36 mm±0.73 mm; internal rotation of 0.62°±1.49°, MTPM of 1.05 mm±0.68 mm). All the migration values measured were small. No late-onset migration was observed. This study suggests that the Cerafit® implants are stable after 10 years. Thus, RSA could be the best tool to assess long-term implant behaviour.

Radiostereometric migration analysis of the Lubinus SP II hip stem: 59 hips followed for 2 years.

The aim of this prospective study was to analyze the migration pattern of the Lubinus SP II hip stem and to evaluate the clinical results. Fifty-nine patients were followed for 2 years. Translational and rotational micromotion of the implant was measured by radiostereometric analysis (RSA) and the Harris hip score (HHS), and the Charnley classification was used to assess the clinical outcome. Although there was a very small, but statistically significant, distal migration of 0.04±0.83 mm, the prosthesis was found stable at 2 years of follow-up. The main migration in this direction took place between 6 months and 1 year. Maximum total point motion (MTPM) showed a mean of 0.99±0.69 mm. Good clinical outcome with HHS results of 42±11 before and 79±16 at 2 years after surgery was observed. The Charnley classification showed increasing additional impairments in the 2-year interval, which is likely to influence the HHS results of future follow-ups. The migration values measured in the present study are far below the thresholds considered clinically relevant in literature. Thus, the conclusion can be drawn that the implant is not at risk for early aseptic loosening. Long-term RSA is required to assess possible late migration.

Comparison of cortical and cancellous bone remodeling of the pelvis after press-fit cup total hip arthroplasty dependent on patient and prosthesis-specific characteristics: a computed tomography-assisted osteodensitometry study in vivo.

Even though periprosthetic bone loss is common after total hip arthroplasty, there is no scientific evidence whether it compromises the survival of the prosthesis. Using quantitative computed tomography-assisted osteodensitometry, we determined the pattern of periacetabular bone density (BD) changes of two different press-fit cups (54 hips) 10 days, 1 year and 3 years post-operatively. We measured cortical and cancellous BD at three points of time and evaluated the effects of patient-specific characteristics [age, gender, body mass index (BMI)], clinical function, and BD at index operation. Cancellous BD decreased in all periacetabular regions by up to -52% (p ≤ 0.001). In contrast, cortical BD above the dome of the cup remained constant while at the level of the cup it decreased by up to -17% (p ≤ 0.001). Older patients had significantly lower cortical (ventral and dorsal) and cancellous (cranial) BD values, obese patients had a higher cortical BD ventral, and patients with excellent clinical results had a higher cancellous BD ventral and dorsal to the cup. Changes in BD suggest high stress shielding of retroacetabular cancellous bone, while load is transmitted to cortical bone above the dome of the cup. Patient-specific characteristics were shown to affect BD, but long-term analysis is needed to show whether these effects are of clinical importance.

Quantitative computed tomography-assisted osteodensitometry of the pelvis after press-fit cup fixation: a prospective ten-year follow-up.

BACKGROUND: As a follow-up of a previously reported three-year study, we analyzed the periprosthetic acetabular cortical and cancellous bone density changes at ten years after implantation of a press-fit cup. METHODS: Prospective clinical, radiographic, and quantitative computed tomography examinations were performed within ten days and at mean periods of one, three, and ten years after total hip arthroplasty with a press-fit cup, a femoral stem with a tapered design, and alumina-alumina pairing. Periacetabular cortical and cancellous bone density (mg CaHA/mL) in the cranial, ventral, and dorsal regions about the cup were measured for twenty-four hips in vivo. RESULTS: All acetabular cups showed radiographic signs of stable ingrowth, and no acetabular component had to be revised. The loss of periacetabular cancellous bone density about the cup was as much as -37% cranially, -60% ventrally, and -71% dorsally; the decrease was progressive between the one-year and three-year examinations only. In contrast, cortical bone density above the dome of the acetabular cup remained constant throughout the ten-year follow-up. A moderate change in cortical bone density of -5% to -18% was seen at the level of the cup ten years postoperatively. CONCLUSIONS: Both periacetabular cortical and cancellous bone density changes were nonprogressive between the three-year and ten-year examinations after press-fit cup fixation.

An ABJS Best Paper: Progressive cancellous and cortical bone remodeling after press-fit cup fixation: a 3-year followup.

Periprosthetic bone loss after total hip arthroplasty is common. It can be progressive and, in the extreme, may compromise survival of the prosthesis. With quantitative computed tomography, we determined the pattern of periacetabular cortical and cancellous bone density changes after press-fit cup implantation with alumina liners. We recruited 24 patients (24 hips; 15 men and nine women) with degenerative joint disease and used a press-fit cup with an alumina/alumina pairing. The average patient age was 57 years. Computed tomography examinations were performed 10 days, 1 year, and 3 years after the index operation. Cancellous bone density decreased in all periacetabular regions by as much as -66%; the decrease was progressive between the 1- and 3-year examinations. In contrast, cortical bone density above the dome of the cup remained constant but progressively decreased by as much as -22% at the level of the cup 3 years postoperatively. Within the first 3 postoperative years, progressive periacetabular remodeling of cancellous and cortical bone structures was observed after press-fit cup fixation. The bone density changes suggest high stress shielding of retroacetabular cancellous bone while load is transmitted solely to the cortical bone above the dome of the cup.