Preserved Periprosthetic Bone Stock at 5 years Post-operatively with Uncemented Short Hip Stem in Both Collared and Collarless Version

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 Nov 29

PMID 34841462

Citations 6

Authors

Ola Belfrage

Erik Weber

Martin Sundberg

Gunnar Flivik

Affiliations

Soon will be listed here.

Abstract

Introduction: Previous bone density studies have generally shown bone resorption around both cemented and uncemented total hip arthroplasty (THA) stems. This is presumed to be due to stress shielding. Short stems have been introduced partly to preserve bone in the proximal femur by a more physiological loading of the bone. The purpose of this study was to evaluate bone remodeling around a short, fully hydroxyapatite-coated titanium stem that comes in a collared and collarless version.

Patients And Methods: A prospective cohort of 50 patients included in a study evaluating the Furlong Evolution stem has been followed for 5 years. Examination was done with dual energy X-ray absorptiometry (DXA) postoperatively, at 1, 2 and 5 years. Clinical outcome was followed with radiography and both general and hip specific outcome measures.

Results: The two versions of the stem behaved similarly regarding bone remodeling. After an initial decrease up to 1 year, bone mineral density (BMD) increased in all Gruen zones up to 2 years and at 5 years bone stock was still preserved compared with postoperatively (net BMD + 1.2% (95% CI - 0.4 to 2.8)). Increase in BMD occurred mainly in the greater trochanter and distally around the stem with a decrease in the calcar area. Both versions showed excellent clinical outcome up to 5 years.

Conclusion: This short stem seems to preserve proximal bone stock up to 5 years, exhibiting similar behaviour both with and without a collar.

Trial Registration Number And Date Of Registration: ClinicalTrials.gov, (identifier: NCT01894854). July 10, 2013.

Citing Articles

No differences in clinical and radiographic outcomes between standard offset and high offset short cementless stems.

DAmbrosio A, Bonnomet F, Debordes P, Ramos-Pascual S, Kumble A, Saffarini M Arch Orthop Trauma Surg. 2024; 144(8):3401-3411.

PMID: 39168958 DOI: 10.1007/s00402-024-05431-1.

Clinical use of quantitative computed tomography to evaluate the effect of less paraspinal muscle damage on bone mineral density changes after lumbar interbody fusion.

Zhang X, Wang S, Zheng J, Xiao X, Wang H, Peng S Asian Spine J. 2024; 18(3):415-424.

PMID: 38917852 PMC: 11222883. DOI: 10.31616/asj.2023.0447.

Total Hip Replacement with a Fully Hydroxyapatite-Coated Shortened Stem: Five- to Thirteen-Year Follow-Up Results.

Marques Lopez F, Pares Alfonso I, Donaire Hoyas D, Ruiz Morales G, Pons M, Lizano Diez X J Clin Med. 2024; 13(9).

PMID: 38731186 PMC: 11084338. DOI: 10.3390/jcm13092657.

Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.

Ait-Si-Selmi T, Vidalain J, Ramos-Pascual S, Kuratle T, Saffarini M, Dejour E EFORT Open Rev. 2024; 9(4):264-275.

PMID: 38579748 PMC: 11044085. DOI: 10.1530/EOR-22-0091.

Retrospective clinical and X-ray-based outcome analysis of a short-stem hip arthroplasty taking into account the operative learning curve over 7 years in the 3-year control course.

Jahnke A, Kother-Herrmann J, Fonseca Ulloa C, Harz T, Rickert M, Ishaque B Arch Orthop Trauma Surg. 2023; 143(11):6589-6597.

PMID: 37418006 PMC: 10542719. DOI: 10.1007/s00402-023-04977-w.

References

Weber E, Sundberg M, Flivik G . Design modifications of the uncemented Furlong hip stem result in minor early subsidence but do not affect further stability: a randomized controlled RSA study with 5-year follow-up. Acta Orthop. 2014; 85(6):556-61. PMC: 4259023. DOI: 10.3109/17453674.2014.958810. View

Knutsen A, Lau N, Longjohn D, Ebramzadeh E, Sangiorgio S . Periprosthetic femoral bone loss in total hip arthroplasty: systematic analysis of the effect of stem design. Hip Int. 2016; 27(1):26-34. DOI: 10.5301/hipint.5000413. View

Pitto R, Mueller L, Reilly K, Schmidt R, Munro J . Quantitative computer-assisted osteodensitometry in total hip arthroplasty. Int Orthop. 2006; 31(4):431-8. PMC: 2267633. DOI: 10.1007/s00264-006-0257-x. View

Lamb J, Baetz J, Messer-Hannemann P, Adekanmbi I, van Duren B, Redmond A . A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation. Bone Joint J. 2019; 101-B(7):779-786. DOI: 10.1302/0301-620X.101B7.BJJ-2018-1422.R1. View

Nam D, Salih R, Barrack R, Nunley R . An evaluation of proximal femur bone density in young, active patients undergoing total hip arthroplasty at one year postoperatively. Hip Int. 2018; 29(1):51-57. PMC: 6305958. DOI: 10.1177/1120700018761152. View

Schilcher J, Ivarsson I, Perlbach R, Palm L . No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty. 2016; 32(4):1220-1226. DOI: 10.1016/j.arth.2016.11.015. View

Jahnke A, Engl S, Altmeyer C, Jakubowitz E, Seeger J, Rickert M . Changes of periprosthetic bone density after a cementless short hip stem: a clinical and radiological analysis. Int Orthop. 2014; 38(10):2045-50. DOI: 10.1007/s00264-014-2370-6. View

Rahmy A, Gosens T, Blake G, Tonino A, Fogelman I . Periprosthetic bone remodelling of two types of uncemented femoral implant with proximal hydroxyapatite coating: a 3-year follow-up study addressing the influence of prosthesis design and preoperative bone density on periprosthetic bone loss. Osteoporos Int. 2003; 15(4):281-9. DOI: 10.1007/s00198-003-1546-5. View

Cohen B, Rushton N . Accuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg Br. 1995; 77(3):479-83. View

10.

Venesmaa P, Kroger H, Miettinen H, Jurvelin J, Suomalainen O, Alhava E . Monitoring of periprosthetic BMD after uncemented total hip arthroplasty with dual-energy X-ray absorptiometry--a 3-year follow-up study. J Bone Miner Res. 2001; 16(6):1056-61. DOI: 10.1359/jbmr.2001.16.6.1056. View

11.

Weber E, Flivik C, Sundberg M, Flivik G . Migration pattern of a short uncemented stem with or without collar: a randomised RSA-study with 2 years follow-up. Hip Int. 2019; 31(4):500-506. DOI: 10.1177/1120700019888471. View

12.

Khosla S, Riggs B . Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin North Am. 2005; 34(4):1015-30, xi. DOI: 10.1016/j.ecl.2005.07.009. View

13.

Meding J, Ritter M, Keating E, Faris P . Comparison of collared and collarless femoral components in primary uncemented total hip arthroplasty. J Arthroplasty. 1997; 12(3):273-80. DOI: 10.1016/s0883-5403(97)90023-1. View

14.

Brew C, Stockley I, Grainger A, Stone M . Iliopsoas tendonitis caused by overhang of a collared femoral prosthesis. J Arthroplasty. 2010; 26(3):504.e17-9. DOI: 10.1016/j.arth.2009.12.020. View

15.

Boden H, Skoldenberg O, Salemyr M, Lundberg H, Adolphson P . Continuous bone loss around a tapered uncemented femoral stem: a long-term evaluation with DEXA. Acta Orthop. 2007; 77(6):877-85. DOI: 10.1080/17453670610013169. View

16.

Levadnyi I, Awrejcewicz J, Gubaua J, Pereira J . Numerical evaluation of bone remodelling and adaptation considering different hip prosthesis designs. Clin Biomech (Bristol). 2017; 50:122-129. DOI: 10.1016/j.clinbiomech.2017.10.015. View

17.

Albanese C, Santori F, Pavan L, Learmonth I, Passariello R . Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems: 37 patients followed for 3 years. Acta Orthop. 2009; 80(3):291-7. PMC: 2823205. DOI: 10.3109/17453670903074467. View

18.

Nilsdotter A, Lohmander L, Klassbo M, Roos E . Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003; 4:10. PMC: 161815. DOI: 10.1186/1471-2474-4-10. View

19.

Salemyr M, Muren O, Ahl T, Boden H, Eisler T, Stark A . Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthop. 2015; 86(6):659-66. PMC: 4750763. DOI: 10.3109/17453674.2015.1067087. View

20.

Yan S, Weber P, Steinbruck A, Hua X, Jansson V, Schmidutz F . Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. Int Orthop. 2017; 42(9):2077-2086. DOI: 10.1007/s00264-017-3691-z. View