Osteoporosis International

, Volume 15, Issue 4, pp 281–289 | Cite as

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

  • A. I. A. Rahmy
  • T. Gosens
  • G. M. Blake
  • A. Tonino
  • I. Fogelman
Original Article

Abstract

Periprosthetic bone loss is a major cause of concern in patients undergoing total hip arthroplasty (THA). Further studies are required to identify the factors determining the pattern of bone remodelling following THA and obtain improvements in the design and durability of prostheses. In this study, we monitored periprosthetic bone loss around two different types of hydroxyapatite coated femoral implant over a 3-year period to evaluate their design and investigate the relationship with the preoperative bone mineral density (BMD) at the spine, hip and forearm. Sixty patients (35 F, 25 M, mean age 63 years, range 46–75 years) undergoing THA were randomised to either the Anatomic Benoist Girard (ABG) or Mallory-Head (MH) femoral stem. Preoperative dual-energy X-ray absorptiometry (DXA) scans were acquired of the posteroanterior (PA) and lateral lumbar spine, the contralateral hip and the non-dominant forearm. Postoperative DXA scans were performed to measure periprosthetic BMD at 10 days (treated as baseline), 6 weeks, and 3, 6, 12, 24 and 36 months after THA using a standard Gruen zone analysis. Results were expressed as the percentage change from baseline and the data examined for the differences in bone loss between the different Gruen zones, between the ABG and MH stems, and the relationship with preoperative BMD. A total of 50 patients (24 ABG, 26 MH) completed the study. Three months after THA there was a statistically significant BMD decrease in every Gruen zone that varied between 5.6% and 13.8% for the ABG prosthesis and between 3.8% and 8.7% for the MH prosthesis. Subsequently, in most zones BMD reached a plateau or showed a small recovery. However, BMD continued to fall in Gruen zones 1 and 7 in ABG patients and Gruen zone 1 in MH patients. Bone loss was less in every Gruen zone in MH patients compared with ABG with the largest difference (10%, P=0.018) in Gruen zone 7. Highly significant relationships were found between periprosthetic bone loss and preoperative BMD measured at the PA spine (P<0.001), total hip (P=0.004) and total distal radius (P<0.001). This study showed differences between two different designs of hydroxyapatite-coated implant that confirmed that prosthesis design influences periprosthetic bone loss. The study also showed that patients’ bone density measured at the spine, hip or forearm at the time of operation was a major factor influencing bone loss around the femoral stem.

Keywords

Bone mineral density Bone quality Dual energy X-ray absorptiometry Periprosthetic bone loss Total hip arthroplasty 

References

  1. 1.
    Huo MH, Cook SM (2001) What’s new in hip arthroplasty. J Bone Joint Surg [Am] 83A:1595–1610Google Scholar
  2. 2.
    Huiskes R, Weinans H, van Reitbergen B (1992) The relationship between stress shielding and bone resorption around total hip stems and effects of flexible materials. Clin Orthop 274:124–134PubMedGoogle Scholar
  3. 3.
    Niinimaki T, Junila J, Jalovaara P (2001) A proximal fixed anatomic stem reduces stress shielding. Int Orthop 25:85–88CrossRefPubMedGoogle Scholar
  4. 4.
    Sychterz CJ, Engh CA (1996) The influence of clinical factors on periprosthetic bone remodeling. Clin Orthop 322:285–292PubMedGoogle Scholar
  5. 5.
    Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE (1992) Producing and avoiding stress shielding—laboratory and clinical observations of noncemented total hip arthoplasty. Clin Orthop 274:79–96PubMedGoogle Scholar
  6. 6.
    Schmalzried TP, Callaghan JJ (1999) Wear in total hip and knee replacements. J Bone Joint Surg [Am] 81A:115–136Google Scholar
  7. 7.
    West JD, Mayor MB, Collier JP (1987) Potential errors inherent in quantitative densitometric analysis of orthopedic radiographs—a study of total hip arthroplasty. J Bone Joint Surg [Am] 69A:58–64Google Scholar
  8. 8.
    Engh CA Jr, McAulley JP, Sychterz CJ, Sacco ME, Engh CA Sr (2000) The accuracy and reproducibility of radiographic assessment of stress-shielding—a postmortem analysis. J Bone Joint Surg [Am] 82A:1414–1420Google Scholar
  9. 9.
    Smart RC, Barbagallo S, Slater GL, Kuo RS, Butler SP, Drummond RP, Sekel R (1996) Measurement of periprosthetic bone density in hip arthroplasty using dual-energy X-ray absorptiometry–reproducibility of measurements. J Arthroplasty 11:445–452PubMedGoogle Scholar
  10. 10.
    Rahmy AI, Tonino AJ, Tan W, Ter Riet G (2000) Precision of dual energy X-ray absorptiometry in determining periprosthetic bone mineral density of the hydroxyapatite coated hip prosthesis. Hip Int 10:83–90Google Scholar
  11. 11.
    Martini F, Lebherz C, Mayer F, Leichtle U, Kremling E, Sell S (2000) Precision of the measurements of periprosthetic bone mineral density in hips with custom made femoral stem. J. Bone Joint Surg [Br] 82B:1065–1071Google Scholar
  12. 12.
    Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW (1993) Dual-energy X-ray absorptiometery measurement of bone mineral density around porous-coated cementless femoral implants—methods and preliminary results. J Bone Joint Surg [Br] 75:279–287Google Scholar
  13. 13.
    Marchetti ME, Steinberg GG, Greene JM, Jenis LG, Baran DT (1996) A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty. J Bone Miner Res 11:1033–1039PubMedGoogle Scholar
  14. 14.
    McCarthy CK, Steinberg GG, Agren M, Leahey D, Wyman E, Baran DT (1991) Quantifying bone loss from the proximal femur after total hip arthroplasty. J Bone Surg [Br] 73:774–778Google Scholar
  15. 15.
    Kiratli BJ, Checovich MM, McBeath AA, Wilson MA, Heiner JP (1996) Measurement of bone mineral density by dual-energy X-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem. J Arthroplasty 11:184–193PubMedGoogle Scholar
  16. 16.
    Kroger H, Vanninen E, Overmyer M, Miettinen H, Rushton N, Suomalainen O (1997) 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 12:487–492PubMedGoogle Scholar
  17. 17.
    Trevisan C, Bigoni M, Randelli G, Marinoni EC, Peretti G, Ortolani S (1997) Periprosthetic bone density around fully hydroxyapatite coated femoral stem. Clin Orthop 340:109–117PubMedGoogle Scholar
  18. 18.
    Spittlehouse AJ, Smith TW, Eastell A (1998) Bone loss around 2 different types of hip prostheses. J Arthoplasty 13:422–427Google Scholar
  19. 19.
    Kroger H, Miettinen H, Arnala I, Koski E, Rushton N, Suomalainen O (1996) Evaluation of periprosthetic bone using dual-energy X-ray absorptiometry. Precision of the method and effect of operation on bone mineral density. J. Bone Miner Res 11:1526–1530PubMedGoogle Scholar
  20. 20.
    Rosenthall L, Bobyn JD, Tanzer M (1999) Bone densitometry: influence of prosthetic design and hydroxyapatite coating on regional adaptive bone remodelling. Int Orthop 23:325–329CrossRefPubMedGoogle Scholar
  21. 21.
    Wixson RL, Stulberg SD, Van Flandern GJ, Puri L (1997) Maintenance of proximal bone mass with an uncemented femoral stem: analysis with dual energy X-ray absorptiometry. J Arthroplasty 12:365–372PubMedGoogle Scholar
  22. 22.
    Venesmaa PK, Kroger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM (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 16:1056–1061PubMedGoogle Scholar
  23. 23.
    Sabo D, Reiter A, Simank HG, Thomsen M, Lukoschek M, Ewerbeck (1997) Periprosthetic mineralization around cementless total hip endoprosthesis: Longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno with DEXA. Calcif Tissue Int 62:177–182CrossRefGoogle Scholar
  24. 24.
    Rosenthall L, Bobyn JD, Brooks CE (1999) Temporal changes of periprosthetic bone density in patients with a modular noncemented femoral prosthesis. J. Arthroplasty 14:71–76Google Scholar
  25. 25.
    Tanzer M, Kantor S, Rosenthall L, Bobyn JD (2001) Femoral remodeling after porous coated total hip arthroplasty with and without hydroxyapatite tricalcium phosphate coating: a prospective randomized trial. J Arthoplasty 16:522–528Google Scholar
  26. 26.
    Nishii T, Sugano N, Masuhara K, Shibuya T, Ochi T, Tamura S (1997) Longitudinal evaluation of time related bone remodeling after cementless total hip arthroplasty. Clin Orthop Rel Res 339:121–131CrossRefGoogle Scholar
  27. 27.
    Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141:17–27PubMedGoogle Scholar
  28. 28.
    Altman DG (1991) Practical statistics for medical research. Chapman Hall, London, pp 327–331Google Scholar
  29. 29.
    Hall ML, Heavens J, Ell P (1991) Variation between femurs as measured by dual-energy X-ray absorptiometry. Eur J Nucl Med 18:38–40PubMedGoogle Scholar
  30. 30.
    Nevitt MC, Lane MN, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR (1995) Radiographic osteoarthritis of the hip and bone mineral density. Arthr Rheum 38:907–916Google Scholar
  31. 31.
    LeBlanc A, Schneider V, Krebs J, Evans H, Jhingran S, Johnson P (1987) Spinal bone density after five weeks of bed rest. Calcif Tissue Int 41:259–261PubMedGoogle Scholar
  32. 32.
    Rodan GA (1992) Introduction to bone biology. Bone 13:S3–S6PubMedGoogle Scholar
  33. 33.
    Kelly TL (1990) Bone mineral density reference databases for American men and women. J Bone Miner Res 5:S249Google Scholar
  34. 34.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC, Lindsay RL (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489CrossRefPubMedGoogle Scholar
  35. 35.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMedGoogle Scholar
  36. 36.
    Hosking D, Chilvers CE, Christiansen C, Ravn P, Wasnich R, Ross P, McClung M, Balske A, Thompson D, Daley M, Yates AJ (1998) Prevention of bone loss in postmenopausal women under 60 years of age. Early postmenopausal intervention cohort study group. N Engl J Med 338:485–492PubMedGoogle Scholar
  37. 37.
    Tonino RP, Meunier PJ, Emkey R, Rodriguez-Portales JA, Menkes C-J, Wasnich RD, Bone HG, Santora AC, Wu M, Desai R, Ross PD (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. J Clin Endocrinol Metab 85:3109–3115PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • A. I. A. Rahmy
    • 1
  • T. Gosens
    • 2
  • G. M. Blake
    • 3
  • A. Tonino
    • 2
  • I. Fogelman
    • 3
  1. 1.Department of Nuclear MedicineAtrium Medical CentreHeerlenThe Netherlands
  2. 2.Department of OrthopaedicsAtrium Medical CentreHeerlenThe Netherlands
  3. 3.Department of Nuclear MedicineGuy’s HospitalLondonUnited Kingdom

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