Immediate Changes of Bone Density Caused by the Implantation of a Femoral Stem - A Dexa Study

2011 ◽  
Vol 21 (6) ◽  
pp. 706-712 ◽  
Author(s):  
Ulf G. Leichtle ◽  
Jeremi Leasure ◽  
Franz Martini ◽  
Carmen I. Leichtle
Keyword(s):  
Bone Density ◽  
Bone Loss ◽  
Femoral Stem ◽  
Periprosthetic Bone ◽  
Experimental Conditions ◽  
Press Fit ◽  
Custom Made ◽  
Femoral Stems ◽  
Cementless Prosthesis ◽  
Post Implantation

Considerable immediate periprosthetic bone density changes after implantation of femoral stems have been observed comparing DEXA measurements taken pre- and post-operatively. This is important in relation to the interpretation of DEXA studies. We analysed these density changes under standardised experimental conditions. Five human femora were implanted with a custom made femoral stem and ten femora with a standard cementless prosthesis. Densitometry was performed at various stages of implantation. Following rasping only slight density changes were noted (–2.7% to +0.7%). Comparing post-implantation and pre-operative measurements, all custom made stems with a proximal press-fit demonstrated clear increases in proximal periprosthetic bone density of +11% and +14%. In contrast, the standard prosthesis with a distal press-fit showed a loss of –5% and –2% in the proximal zones. Measurements following removal of the implants demonstrated hardly any density changes (0% to –4%) compared to the pre-operative measurements. We concluded that compacting of trabecular bone or bone loss due to rasping are not the main causes of density changes. Substantial measuring errors exist. For examination of periprosthetic bone density changes, pre-operative initial measurements should not be used as a baseline for comparison. Studies should commence with an immediate postoperative measurement.

scholarly journals Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS)

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. Quayle ◽  
A. Barakat ◽  
A. Klasan ◽  
A. Mittal ◽  
G. Chan ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Femoral Stem ◽  
Leg Length ◽  
Prosthetic Joint ◽  
Articulating Spacer ◽  
Custom Made ◽  
Femoral Stems ◽  
Tissue Factors

Abstract Background There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. Methods Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. Results Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7–7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6–5.1). Conclusions Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.

Periprosthetic Femoral Bone Loss in Total Hip Arthroplasty: Systematic Analysis of the Effect of Stem Design

2016 ◽  
Vol 27 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Ashleen R. Knutsen ◽  
Nicole Lau ◽  
Donald B. Longjohn ◽  
Edward Ebramzadeh ◽  
Sophia N. Sangiorgio
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Fixation Method ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Stem Design ◽  
Total Hip ◽  
Press Fit

Introduction Periprosthetic bone loss may lead to major complications in total hip arthroplasty (THA), including loosening, migration, and even fracture. This study analysed the influence of femoral implant designs on periprosthetic bone mineral density (BMD) after THA. Methods The results of all previous published studies reporting periprosthetic femoral BMD following THA were compiled. Using these results, we compared percent changes in bone loss as a function of: femoral stem fixation, material, and geometry. Results The greatest bone loss was in the calcar region (Gruen Zone 7). Overall, cemented stems had more bone loss distally than noncemented stems, while noncemented stems had more proximal bone loss than cemented stems. Within noncemented stems, cobalt-chromium (CoCr) stems had nearly double the proximal bone loss compared to titanium (Ti) alloy stems. Finally, within noncemented titanium alloy group, straight stems had less bone loss than anatomical, tapered, and press-fit designs. Discussion The findings from the present study quantified percent changes in periprosthetic BMD as a function of fixation method, alloy, and stem design. While no one stem type was identified as ideal, we now have a clearer understanding of the influence of stem design on load transfer to the surrounding bone.

scholarly journals PERIPROSTHETIC BONE DENSITY CHANGES EVALUATION USING COMPUTED TOMOGRAPHY

2005 ◽  
pp. 072-076
Author(s):  
Fidele Likibi ◽  
Michel Assad ◽  
Christine Coillard ◽  
Gilles Chabot ◽  
Charles-H. . Rivard
Keyword(s):  
Computed Tomography ◽  
Bone Density ◽  
Computer Tomography ◽  
Lumbar Fusion ◽  
Titanium Implant ◽  
Density Variation ◽  
Periprosthetic Bone ◽  
Sheep Model ◽  
Post Implantation

The aim of this study was to examine the effect of the presence of two types of metallic intervertebral lumbar fusion implants (a porous nitinol and a hollow titanium cylindrical implants) in the implant peripheral tissue after 3, 6 and 12 months post-implantation in a lumbar sheep model in order to evaluate and compare the biofunctionality and biocompatibility of both implants. 19 sheep were used to evaluate this bone density variation using computer tomography (CT). 16 of them received both implants at either level L2–L3 or L4–L5 and 3 other non-treated animals were used as controls. Results indicated that PNT obtained a superior biofunctionality that the conventional titanium implant. However, the biocompatibility of porous nitinol seemed comparable to that of titanium – a well-known long-term implant material.

scholarly journals Long-term bone remodelling around ‘legendary’ cementless femoral stems

2018 ◽  
Vol 3 (2) ◽  
pp. 45-57 ◽  
Author(s):  
Charles Rivière ◽  
Guido Grappiolo ◽  
Charles A. Engh ◽  
Jean-Pierre Vidalain ◽  
Antonia-F. Chen ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Remodelling ◽  
Bone Ingrowth ◽  
Stress Shielding ◽  
Implant Design ◽  
Periprosthetic Bone ◽  
Femoral Stems ◽  
Periprosthetic Bone Loss ◽  
Load Pattern

Bone remodelling around a stem is an unavoidable long-term physiological process highly related to implant design. For some predisposed patients, it can lead to periprosthetic bone loss secondary to severe stress-shielding, which is thought to be detrimental by contributing to late loosening, late periprosthetic fracture, and thus rendering revision surgery more complicated. However, these concerns remain theoretical, since late loosening has yet to be documented among bone ingrowth cementless stems demonstrating periprosthetic bone loss associated with stress-shielding. Because none of the stems replicate the physiological load pattern on the proximal femur, each stem design is associated with a specific load pattern leading to specific adaptive periprosthetic bone remodelling. In their daily practice, orthopaedic surgeons need to differentiate physiological long-term bone remodelling patterns from pathological conditions such as loosening, sepsis or osteolysis. To aid in that process, we decided to clarify the behaviour of the five most used femoral stems. In order to provide translational knowledge, we decided to gather the designers’ and experts’ knowledge and experience related to the design rationale and the long-term bone remodelling of the following femoral stems we deemed ‘legendary’ and still commonly used: Corail (Depuy); Taperloc (Biomet); AML (Depuy); Alloclassic (Zimmer); and CLS-Spotorno (Zimmer).Cite this article: EFORT Open Rev 2018;3:45-57. DOI: 10.1302/2058-5241.3.170024

scholarly journals Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem

2011 ◽  
Vol 82 (4) ◽  
pp. 410-416 ◽  
Author(s):  
Mona Nysted ◽  
Pål Benum ◽  
Jomar Klaksvik ◽  
Olav Foss ◽  
Arild Aamodt
Keyword(s):  
Bone Loss ◽  
Femoral Stem ◽  
Periprosthetic Bone ◽  
Periprosthetic Bone Loss

Changes of Periprosthetic Bone Density after Implantation of an Anatomical Femoral Stem with Cemented and Cementless Fixation

2011 ◽  
Vol 21 (3) ◽  
pp. 317-324 ◽  
Author(s):  
Ralf Bieger ◽  
Franz Martini ◽  
Heiko Reichel ◽  
Ralf Decking
Keyword(s):  
Bone Density ◽  
Femoral Stem ◽  
Cementless Fixation ◽  
Periprosthetic Bone

scholarly journals Influence of alendronate therapy on the results of densitometric examination after implantation of total hip endoprosthesis

2021 ◽  
Vol 13 (1) ◽  
pp. 32-38
Author(s):  
Ilir Shabani ◽  
Antonio Gavrilovski ◽  
Vilijam Velkovski ◽  
Nenad Atanasov ◽  
Shaban Memeti ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Bone Loss ◽  
Bone Mass ◽  
Bone Mineral ◽  
Mineral Content ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Hip Endoprosthesis ◽  
Periprosthetic Bone Loss ◽  
Post Implantation

The development of aloarthroplasty of the hip is continuously rising. After implantation of a total cement-free hip endoprosthesis, often there is a periprosthetic femoral bone loss. Alendronate has been shown to be a potent inhibitor of bone resorption activity; it inhibits osteoclastic bone resorption, increases bone mass, and plays a significant role in post-implantation stabilization of the femur. The aim of this study was to determine the effect of alendronate on osteointegration of hip endoprosthesis.Material and methods: The study analyzed 10 patients operated on with implantation of a total cement-free hip endoprosthesis (THP). The included patients were examined by a radiographic method at 6 and 12 months and DXA method at 6 and 12 months. Results: The study showed differences in the values of bone mineral density and bone mineral content in the interval between 6 and 12 months in patients undergoing THP, and hence we can conclude that alendronate therapy after THP implantation reduced periprosthetic loss of bone mass and implant stiffening. Alendronate is a proven inhibitor of periprosthetic bone loss that occurs after prirmary impantation of a total cement-free hip endoprosthesis.

scholarly journals Predicting Bone Remodeling in Response to Orthopedic Implantations: Computational Study Using a Mechano-Biochemical Model

2021 ◽  
Author(s):  
Pouria Tavakkoli Avval
Keyword(s):  
Bone Density ◽  
Bone Loss ◽  
Bone Remodeling ◽  
Bone Fracture ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Premature Failure ◽  
Gruen Zone ◽  
Periprosthetic Bone Loss

Periprosthetic bone loss following orthopedic implantations is a serious concern leading to the premature failure of the implants. Therefore, investigating bone remodeling in response to orthopedic implantations is of paramount importance for the purpose of designing long lasting prostheses. In this study, a predictive bone remodeling model (Thermodynamic-based model) was employed to simulate the long-term response of femoral density to total hip arthroplasty (THA), bone fracture plating and intramedullary (IM) nailing. The ability of the model in considering the coupling effect between mechanical loading and bone biochemistry is its unique characteristic. This research provided quantitative data for monitoring bone density changes throughout the femoral bone. The results obtained by the thermodynamic-based model agreed well with the bone morphology and the literature. The study revealed that the most significant periprosthetic bone loss in response to THA occurred in calcar region (Gruen zone 7). Conversely, the region beneath the hip stem (Gruen zone 4) experienced the lowest bone mineral density (BMD) changes. It was found that the composite hip implant and IM nail were more advantageous over the metallic ones as they induced less stress shielding and provided more uniform bone density changes following the surgery. The research study also showed that, due to plating, the areas beneath the bone fracture plate experienced severe bone loss. However, some level of bone formation was observed at the vicinity of the most proximal and distal screw holes in both lateral and anterior plated femurs. Furthermore, in terms of long-term density distributions, the anterior plating was not superior to the lateral plating.

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