The authors declare that they have no competing interests.
WS: study conception, writing of manuscript, final analysis and interpretation of data, FB: drafting and critical revising of manuscript, RB: acquisition of data, blinded analysis and interpretation of data. RS: acquisition of data, AS: conception and study design, drafting of manuscript, approval of statistics. All authors read and approved the final manuscript.
Bone resorption in the proximal femur due to stress shielding has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to prospectively investigate the in vivo changes of bone-mineral density as a parameter of bone remodeling around a short, femoral neck prosthesis over the first 5 years following implantation. The secondary goal was to report on its clinical outcome.
We are reporting on the changes of bone mineral density of the proximal femur and the clinical outcome up to five years after implantation of a short femoral neck prosthesis. Bone mineral density was determined using dual energy x-ray absorptiometry, performed 10 days, three, 12 and 60 months after surgery. 20 patients with a mean age of 47 years (range 17 to 65) were clinically assessed using the Harris Hip Score. The WOMAC was used as a patient-relevant outcome-measure.
In contrast to conventional implants DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation. The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 91 points and 95 points at 60 months, the global WOMAC index from 5.3 preoperatively to 0.8 at 12 months and 0.6 at 60 months postoperatively.
At 60 months after implantation of a short femoral neck prosthesis, all regions except one (region of interest #5) showed no significant changes in BMD compared to baseline measurements at 10 days which is less to the changes in bone mineral density seen in conventional implants.
Wolff J. Das Gesetz der Transformation der Knochen. Berlin: Hirschwald; 1892.
Chow R, Harrison JE, Notarius C. Effect of two randomised exercise program- mes on bone mass of healthy postmenopausal women. Br Med J (Clin Res Ed). 1987;295:1441–4. CrossRef
Schönau E, Fricke O. Muskeln und Knochen - eine funktionelle Einheit. Deutsches Ärzteblatt. 2006;103:3414–9.
Jacobs JJ, Sumner DR, Galante JO. Mechanisms of bone loss associated with total hip replacement. Orthop Clin North Am. 1993;24:583–90. PubMed
Rahmy AI, Gosens T, Blake GM, Tonino A, Fogelmann I. Periprosthetic bone remodeling 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. 2004;15:281–9. CrossRefPubMed
Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, et al. Changes in bone mineral densitiy in the proximal femur after cementless total hip arthroplasty. A five-year longitudinal study. J Bone Joint Surg Br. 2004;86:20–6. PubMed
Karrholm J, Garellick G, Herberts P. In: Register SNHA, editor. Annual Report 2005. Göteborg. Sweden: Swedish National Hip Arthroplasty Register; Sahlgrenska University Hospital; 2005. p. 1–86.
Decking R, Puhl W, Simon U, Claes LE. Changes in strain distribution of loaded proximal femora caused by different types of cementless femoral stems. Clin Biomech. 2006;21:495–501. CrossRef
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–55. PubMed
Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Elke R, et al. Evaluation of a German Version of WOMAC Arthrosis Index. Z Rheumatol. 1996;55:40–9. PubMed
Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27. PubMed
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32. PubMed
Engh CA, Bobyn JD, Glassman AH. Porous coated hip replacement. The factors governing bone ingrowth, stress shielding and clinical results. J Bone and Joint Surg Br. 1987;69:45–55.
Kwon Y-M, Fehring TK, Lombardi AV, Barnes CL, Cabanela ME, Jacobs JJ. Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society. J Arthroplasty. 2014;29:2060–4. CrossRefPubMed
Zeh A, Weise A, Vasarhelyi A, Bach AG, Wohlrab D. Medium-term results of the Mayo™ short-stem hip prosthesis after avascular necrosis of the femoral head. Z Orthop Unfall. 2011;149:200–5. PubMed
Götze C, Ehrenbrink J, Ehrenbrink H. Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty. Z Orthop Unfall. 2010;148:398–405. PubMed
Fokter SK, Sarler T, Strahovnik A, Repse-Fokter A. Results of total hip arthroplasty using a bionic stem. Int Orthop. in press.
Koebke J, Xepulias P, Thomas W. CUT type femur neck prosthesis--a functional morphologic analysis]. Biomed Tech (Berl). 2000;45:135–40. CrossRef
Yamaguchi K, Masuhara K, Ohzono K, Sugano N, Nishii T, Ochi T. Evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. The influence of the extent of porous coating. J Bone Joint Surg Am . 2000; 82:1426-31.
Kröger H, Vanninen E, Overmyer M, Miettinen H, Rushton N, Suomalainen O. Periprosthetic 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. 1997;12:487–92.
Venesmaa PK, Kröger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM. 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;16:1056–61
- Bone mineral density after implantation of a femoral neck hip prosthesis – a prospective 5 year follow-up
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II