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Is there a significant decrease in the femoral cortical bone around Furlong® stems after 18 years of follow-up?

  • Enric Cruz
  • Luis NateraEmail author
  • Montserrat Mitjans
  • Carlos Antón
  • Emili Cañete
  • Eva Cases
Original Article • HIP - ARTHROPLASTY
  • 23 Downloads

Abstract

Introduction

In the context of total hip arthroplasty (THA), there are several reasons that have motivated the development of short stems. It has been postulated that short stems allow a better conservation of the bone stock if compared to conventional stems. As far as we have knowledge, the quantitative loss of diaphyseal bone stock in patients with standard femoral stems has not been fully described.

The aim of this study was to provide evidences about the thickness of the cortical bone at the diaphysis in patients who have undergone unilateral THA with Furlong® stems with a minimum follow-up of 18 years.

Patients and methods

A retrospective study of patients who underwent THA in a single hospital was performed. The inclusion criteria were patients who had undergone a non-cemented elective THA with a Furlong® stem, minimum follow-up of 18 years, and contralateral femur and hip without history of previous surgical procedures. The follow-up analysis was performed by means of radiological examinations performed at the last follow-up visit. Data related to the sex, age at surgery and adverse events registered during the follow-up were gathered. The cortical thickness index (CTI) and cortical thickness (CT) assessed at the last follow-up visit in anteroposterior pelvic X-rays were analyzed, both in the operated hip and in the non-operated hip (which was used as control). Calibration of the measurements was done by means of using the circumference of the head of the THA.

Results

The total number of patients who met the inclusion criteria was 22. There were 14 women and eight men. There were 12 left hips. The mean age at the time of surgery was 59.32 ± 6.83 (range 50–70) years. The mean follow-up was 20.86 ± 1.90 (range 18–24) years. The CTI was found to be 11.93% greater in the non-operated hips. The CT measured at 3 cm and 6 cm from lesser trochanter, and at 9 cm from the greater trochanter, was found to be 21.64%, 15.33% and 18.73% greater in the non-operated hips, respectively.

Conclusion

After a minimum of 18 years from the implantation of a Furlong® stem, the bone density that surrounds the implant seems to involve a cortical bone ten percent less thick than the cortical bone of the non-operated contralateral side. With this stem, the cortical zones with less CT seem to be the lateral cortex at 9 cm from the greater trochanter, and the medial cortex at 3 and 6 cm from the lesser trochanter.

Level of evidence

III, retrospective case–control study.

Keywords

Cortical thickness index Cortical thickness Total hip arthroplasty Bone quality Stress shielding 

Notes

Acknowledgements

Authors would like to thank the Epidemiology Department of Hospital General de Granollers for their collaboration in the statistical calculations done in this study.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest.

References

  1. 1.
    Burchard R, Braas S, Soost C et al (2017) Bone preserving level of osteotomy in short-stem total hip arthroplasty does not influence stress shielding dimensions—a comparing finite elements analysis. BMC Musculoskelet Disord 18:343.  https://doi.org/10.1186/s12891-017-1702-2 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Götze C, Ehrenbrink J, Ehrenbrink H (2010) Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty. Z Orthop Unfall 148:398–405.  https://doi.org/10.1055/s-0030-1250151 CrossRefPubMedGoogle Scholar
  3. 3.
    Giardina F, Castagnini F, Stea S et al (2018) Short stems versus conventional stems in cementless total hip arthroplasty: a long-term registry study. J Arthroplasty 33:1794–1799.  https://doi.org/10.1016/j.arth.2018.01.005 CrossRefPubMedGoogle Scholar
  4. 4.
    Brinkmann V, Radetzki F, Delank KS et al (2015) A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses. J Orthop Traumatol 16:237–243.  https://doi.org/10.1007/s10195-015-0335-1 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nguyen BN, Hoshino H, Togawa D, Matsuyama Y (2018) Cortical thickness index of the proximal femur: a radiographic parameter for preliminary assessment of bone mineral density and osteoporosis status in the age 50 years and over population. Clin Orthop Surg 10:149–156.  https://doi.org/10.4055/cios.2018.10.2.149 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    He Q-F, Sun H, Shu L-Y et al (2018) Radiographic predictors for bone mineral loss: cortical thickness and index of the distal femur. Bone Joint Res 7:468–475.  https://doi.org/10.1302/2046-3758.77.BJR-2017-0332.R1 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Patterson J, Rungprai C, Den Hartog T et al (2016) Cortical bone thickness of the distal part of the tibia predicts bone mineral density. J Bone Joint Surg Am 98:751–760.  https://doi.org/10.2106/JBJS.15.00795 CrossRefPubMedGoogle Scholar
  8. 8.
    Webber T, Patel SP, Pensak M et al (2015) Correlation between distal radial cortical thickness and bone mineral density. J Hand Surg Am 40:493–499.  https://doi.org/10.1016/j.jhsa.2014.12.015 CrossRefPubMedGoogle Scholar
  9. 9.
    Mather J, MacDermid JC, Faber KJ, Athwal GS (2013) Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. J Shoulder Elbow Surg 22:732–738.  https://doi.org/10.1016/j.jse.2012.08.018 CrossRefPubMedGoogle Scholar
  10. 10.
    Sah AP, Thornhill TS, LeBoff MS, Glowacki J (2007) Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos Int 18:1119–1126.  https://doi.org/10.1007/s00198-007-0348-6 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Choi HS, Park SY, Kim YM et al (2016) Medical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopenia 2:13–19.  https://doi.org/10.1016/j.afos.2016.02.003 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Dorr LD, Faugere MC, Mackel AM et al (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14:231–242CrossRefGoogle Scholar
  13. 13.
    Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78:512–523CrossRefGoogle Scholar
  14. 14.
    Venesmaa PK, Kröger HP, Miettinen HJ et al (2001) 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 16:1056–1061.  https://doi.org/10.1359/jbmr.2001.16.6.1056 CrossRefPubMedGoogle Scholar
  15. 15.
    Albanese CV, Rendine M, De Palma F et al (2006) Bone remodelling in THA: a comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report. Hip Int 16(Suppl 3):9–15CrossRefGoogle Scholar
  16. 16.
    Salemyr M, Muren O, Ahl T, Bodén H, Eisler T, Stark A, Sköldenberg O (2015) Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthop 86(6):659–866.  https://doi.org/10.3109/17453674.2015.1067087 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Chen HH, Morrey BF, An KN, Luo ZP (2009) Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty 24:945–950.  https://doi.org/10.1016/j.arth.2008.07.014 CrossRefPubMedGoogle Scholar
  18. 18.
    Bodén HSG, Sköldenberg OG, Salemyr MOf et al (2006) Continuous bone loss around a tapered uncemented femoral stem: a long-term evaluation with DEXA. Acta Orthop 77:877–885.  https://doi.org/10.1080/17453670610013169 CrossRefPubMedGoogle Scholar
  19. 19.
    Castelli CC, Rizzi L (2014) Short stems in total hip replacement: current status and future. Hip Int 24(Suppl 10):S25–S28.  https://doi.org/10.5301/hipint.5000169 CrossRefPubMedGoogle Scholar
  20. 20.
    Bieger R, Ignatius A, Decking R et al (2012) Primary stability and strain distribution of cementless hip stems as a function of implant design. Clin Biomech 27:158–164.  https://doi.org/10.1016/j.clinbiomech.2011.08.004 CrossRefGoogle Scholar
  21. 21.
    Santori FS, Santori N (2010) Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 92–B:1231–1237.  https://doi.org/10.1302/0301-620X.92B9.24605 CrossRefGoogle Scholar
  22. 22.
    Lerch M, von der Haar-Tran A, Windhagen H et al (2012) Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop 36:533–538.  https://doi.org/10.1007/s00264-011-1361-0 CrossRefPubMedGoogle Scholar
  23. 23.
    Cohen B, Rushton N (1995) Accuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg Br 77:479–483CrossRefGoogle Scholar
  24. 24.
    Roth A, Richartz G, Sander K et al (2005) Verlauf der periprothetischen Knochendichte nach Hüfttotalendoprothesenimplantation. Orthopade 34:334–344.  https://doi.org/10.1007/s00132-005-0773-1 CrossRefPubMedGoogle Scholar
  25. 25.
    Kress AM, Schmidt R, Nowak TE et al (2012) 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. Arch Orthop Trauma Surg 132:1111–1119.  https://doi.org/10.1007/s00402-012-1537-0 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hospital General de GranollersGranollersSpain

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