Adaptive bone remodeling around cementless femoral stems with two different designs: fitmore and Alloclassic

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Abstract

Introduction. We hypothesized that a short stem preserves periprosthetic bone mass in the proximal femur after total hip arthroplasty (THA). We performed a comparative analysis of clinical efficiency and X-ray results of the BMD around two cementless femoral stems with two different designs. Purpose. To compare the clinical and radiographic results of the study of adaptive bone remodeling in the proximal femur in patients after implantation of the femoral component and Alloclassic Fitmore Material and methods. We evaluated two groups of patients (mean age 58,3): 26 patients with a short femoral stem Fitmore (Zimmer) and 20 patients with a standard stem Alloclassic (Zimmer). Clinical assessment of the hip condition was made according to Harris scale, supplemented by the evaluation of the pain level for femur by a visual analog scale at three levels. The radiological result was studied according to radiogrammetry and dual-energy X-ray absorptiometry (DXA). Results. Independently from design of the femoral component in both groups of patients was observed a significant clinical improvement. The BMD on the surgery side was measured using of analysis in Gruen zones. The first postoperative measurement was performed after surgery and further in 3, 6 and 12 months. DXA after 3 mo showed progressive loss BMD in all Gruen zones, but more significant in Gruen zones 2, 7 for Fitmore stem group, in Gruen zones 6, 7 for Alloclasic stem group. At 6 mo after THA in all Gruen zones of Fitmore vs Alloclasic femoral stems there were the phase of moderate stabilization. At 12 mo we observed decreased periprosthetic BMD in Gruen zone 1 and 7, however that there are no clinically relevant changes around two different designs of cementless femoral stems. Discussion. It isn’t dependent on design of a metal stem we showed progressive remodeling periprosthetic BMD in the proximal parts of hip (Gruen zone 1, 7) and we observed а slighter hypertrophy in the distal parts of femoral stem (stress-shielding). We conclude that using short stems have not benefit in preservation bone of proximal femur.

About the authors

M. P. Karagodina

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: marina.karagodina2011@yandex.ru
radiologist, Russian Federation

I. I. Shubnyakov

Vreden Russian Research Institute of Traumatology and Orthopedics

Academic Secretary, Russian Federation

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics, Mechnikov North-Western State Medical University

director Russian Federation

D. G. Pliev

Vreden Russian Research Institute of Traumatology and Orthopedics

researcher Russian Federation

A. O. Denisov

Vreden Russian Research Institute of Traumatology and Orthopedics

head of hip pathology department Russian Federation

References

  1. Макаров М.А., Макаров С.А., Павлов В.П., Вардикова Г.Н. Стрессовое ремоделирование костной ткани после эндопротезирования крупных суставов и его консервативная коррекция. Совpeменная ревматология. 2009; (1):62-67.
  2. Сеидов И.И., Загородний Н.В., Хаджихараламбус К., Веяль Н.М. Клинико-рентгенологическое обоснование применения бедренных компонентов проксимальной фиксации при эндопротезировании тазобедренного сустава. Гений ортопедии. 2012; (1):19-24.
  3. Тихилов Р.М. Конструктивные особенности различных компонентов эндопротеза тазобедренного сустава. В кн.: Руководство по эндопротезированию тазобедренного сустава. СПб., 2008. Гл. 4. С. 54-117.
  4. Тихилов Р.М., Шубняков И.И., Коваленко А.Н. Черный А.Ж., Муравьева Ю.В., Гончаров М.Ю. Данные регистра эндопротезирования тазобедренного сустава РНИИТО им. Р.Р. Вредена за 2007–2012 годы. Травматология и ортопедия России. 2013; (3):167-190.
  5. Тихилов Р.М., Шубняков И.И. Основные факторы, влияющие на эффективность эндопротезирования тазобедренного сустава. В кн.: Руководство по хирургии тазобедренного сустава. СПб.; 2014. Гл. 7. С. 221-256.
  6. Barnett E., Nordin B.E. The radiological diagnosis of osteoporosis: a new approach. Clin Radiol. 1960; 11:166-174.
  7. Brinkmann V., Radetzki F., Delank K.S., Wohlrab D., Zeh A. A prospective randomized radiographic and dualenergy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern shortstemmed femoral prostheses. J Orthop Traumatol. 2015; 16(3):237-243.
  8. Brodner W., Bitzan P., Lomoschitz F., Krepler P,. Jankovsky R., Lehr S. et al. Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. A fiveyear longitudinal study. J Bone Joint Surg Br. 2004; 86(1):206.
  9. Bugbee W.D., Culpepper W.J. 2nd, Engh C.A. Jr., Engh C.A. Sr. Long-term clinical consequences of stressshielding after total hip arthroplasty without cement. J Bone Joint Surg. Am. 1997; 79(7):1007-1012.
  10. Callaghan J., Dysart S.H., Savory C.G. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of prospective consecutive series. J Bone Joint Surg. 1988; 70-А(2):337-346.
  11. Decking R., Rokahr C., Zurstegge M. et al. Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis. BMC Musculoskelet Disord. 2008; 9:17.
  12. Dorr L.D., Faugere M.C., Mackel A.M., Gruen T.A., Bognar B., Malluche H.H. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993; 14(3):231-242.
  13. Dunn M.G., Maxian S.H. Biomaterials used in orthopaedic surgery. In: Greco R.S. (ed.) Implantation biology, the host response and biomedical devices. Boca Raton, FL: CRC Press; 1994.
  14. E ngh C.A., Bobyn J.D. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res.1988; 231:7-28.
  15. F lecher X., Pearce O., Parratte S. et al. Custom cementless stem improves hip function in young patients at 15-year follow-up. Clin Orthop. 2010; 468(3):747-755.
  16. F reitag T., Hein M.A., Wernerus D., Reichel H., Bieger R. Bone remodelling after femoral short stem implantation in total hip arthroplasty: 1-year results from a randomized DEXA study. Arch Orthop Trauma Surg. 2015; Nov 27. [Epub ahead of print]
  17. Garcia-Cimbrelo E., Cruz-Pardos A., Madero R., Ortega-Andreu M. Total hip arthroplasty with use of the cementless Zweymuller Alloclassic System. J Bone Joint Surg. 2003; 85-А(2):296-303.
  18. Gibbons CE, Davies AJ, Amis AA, Olearnik H, Parker BC, Scott JE Periprosthetic bone mineral density changes with femoral components of differing design philosophy. Int Orthop. 2001; 25(2):89-92.
  19. Grochola L.F., Habermann B., Mastrodomenico N., Kurth A. Comparison of periprosthetic bone remodeling after implantation of anatomic and straight stem prostheses
  20. in total hip arthroplasty. Arch Orthop Trauma Surg. 2008; 128(4):383-392.
  21. H arris W.H. 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. 1969; 51-А(2):737-755.
  22. H awker G.A., Badley E.M., Croxford R. et al. A population-based nested case-control study of the costs of hip and knee replacement surgery. Med Care. 2009; 47:732-741.
  23. H uo M.H., Martin R.P., Zatorski L.E., Keggi K.J. Total hip arthroplasty using the Zweymuller stem implanted without cement: A prospective study of consecutive patients with minimum 3-year follow-up period. J Arthroplasty. 1995; 10(12):793-799.
  24. Katz J.N., Phillips C.B., Baron J.A. et al. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum. 2003; 48(2):560-568.
  25. Khalily C., Lester K. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17(4):463-466.
  26. Kilgus D.J., Shimaoka E.E., Tipton J.S., Eberle R.W. Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg Br. 1993; 75(2):279-287.
  27. Kobayashi S., Eftekhar S.N., Tereyama K. Predisposing factors in fixation failure of femoral prostheses following primary Charnley low friction arthroplasty: A 10- to 20-year follow study. Clin Orthop. 1994; (306): 73-83.
  28. Laine H.J., Puolakka T.J., Moilanen T. et al. The effects of cementless femoral stem shape and proximal surface texture on ‘fit-and-fill’ characteristics and on bone remodeling. Int Orthop. 2000; 24(4):184-190.
  29. Lazarinis S., Mattsson P., Milbrink J. et al. A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthop. 2013; 84(1):32-39.
  30. McMurray A., Grant S., Griffiths S., Letford A. Healthrelated quality of life and health service use following total hip replacement surgery. J Adv Nurs. 2002; 40:663-672.
  31. National Joint Registry of England and Wales 12th Annual Report 2015 http://www.njrcentre.org.uk/njrcentre/Reports,PublicationsandMinutes/Annualreports/tabid/86/Default.aspx
  32. Stukenborg-Colsman C. Femoral neck prostheses.Orthopade. 2007; 36:347-352.
  33. Suckel A., Geiger F., Kinz L. et al. Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis: a 15-year minimum follow-up of 320 hip operations. J Arthroplasty. 2009; 24:846-853.
  34. Swedish Hip Arthroplasty Register 2013 Annual Report. http://www.shpr.se/Libraries/Documents/AnnualReport_2013-04-1_1.sflb.ashx
  35. W alker D.J., Heslop P.S., Chandler C., Pinder I.M.Measured ambulation and self-reported health status following total joint replacement for the osteoarthritic knee. Rheumatology (Oxford). 2002; 41:755-758.
  36. W olf O., Mattsson P., Milbrink J. Effects of postoperative weight-bearing on body composition and bone mineral density after uncemented total hip arthroplasty. J Rehabil Med. 2013; 45(5):498-503.
  37. W olff J. Ueber die Bedeutung der Architectur des spongiösen Substanz. Zentralblatt med. Wissenschaft. 1869; VI: 223-234.

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