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Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

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Abstract

The aim of this prospective study was to measure bone density changes and to assess adaptive bone remodelling after uncemented total hip arthroplasty with a taper-design femoral component using quantitative computer-tomography-assisted osteodensitometry. This method is able to differentiate cortical and cancellous bone structures. Twenty-seven consecutive patients (29 hips) with degenerative joint disease were enrolled in the study. Serial clinical, radiological and CT-osteodensitometry assessments were performed after the index operation. At the 2-year follow-up, the clinical outcome was rated satisfactory in all hips. The radiological assessment showed signs of osteointegration and stable fixation of all cups and stems. We observed a −17% decrease of cortical bone density and −22% decrease of cancellous bone density in the greater trochanter and femoral neck region. Cortical and cancellous bone density decrease at the level of the lesser trochanter was −9% and respectively −4%. We observed small changes of cortical bone density in the diaphyseal regions; in contrast, cancellous bone density increased (range 6% to 27%) in the diaphyseal regions. Overall, a trend of bone density recovery was observed throughout the follow-up period. Periprosthetic bone density changes at the 2-year follow-up are suggestive of stable osteointegration with proximal femoral diaphysis load transfer and moderate metaphyseal stress-shielding.

Résumé

Le but de cette étude prospective est de mesurer par scanner et ostéodensitométrie la densité osseuse et le remodelage osseux après prothèse non cimentée. Cette méthode permet de différencier les structures osseuses corticales et spongieuses. 27 patients consécutifs (29 hanches) présentant une coxarthrose ont été inclus dans cette étude qui a comporté une analyse radiologique, scanographique et ostéodensitométrie. Pour toutes les hanches à deux ans de suivi post-opératoire, le devenir clinique de ces patients était satisfaisant. La radiologie montrait des signes d’ostéointégration et de fixation stables dans toutes les cupules et pour toutes les pièces fémorales. Nous avons observé une diminution de 17% de la densité corticale et de 22% de la densité de l’os spongieux au niveau du grand trochanter et au niveau du calcar. Il existe également une diminution de la densité osseuse au niveau du petit trochanter tant sur le plan cortical 9% qu’au niveau de l’os spongieux 4%. Nous avons également observé de petites modifications de la densité osseuse corticale au niveau de la région diaphysaire, a contrario nous avons également mis en évidence une augmentation de la densité osseuse de l’os spongieux à ce niveau (de 6 à 27%). Ces différentes modifications osseuses nous permettent, à deux ans de suivi post-opératoire, de penser que l’ostéointégration proximale des éléments prothétiques entraîne un transfert de charge et un stress-shielding métaphysaire modéré.

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Acknowledgments

The authors wish to thank Mr. Garnet Tregonning, Dr. Lyndon Bradley, Dr. Godwyn Choy, Dr. Andrew Graydon, Dr. K. Reilly, and Dr. M. Rossaak for their assistance during the clinical follow-ups. The authors also wish to thank Dr. Lutz Mueller, Dr. Tobias Nowak and Dr. Rainer Schmidt for support during implementation of quantitative computer tomography research at the University of Auckland.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Auckland, Auckland, New Zealand

    Rocco P. Pitto, Aknaksha Bhargava, Salil Pandit & Jacob T. Munro

  2. Department of Engineering Science, University of Auckland, Auckland, New Zealand

    Cameron Walker

  3. Orthopaedic Surgeon, South Auckland Clinical School, Middlemore Hospital, Bioengineering Institute, University of Auckland, Level 5, 70 Symonds Street, Auckland, New Zealand

    Rocco P. Pitto

Authors
  1. Rocco P. Pitto
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  2. Aknaksha Bhargava
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  3. Salil Pandit
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  4. Cameron Walker
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  5. Jacob T. Munro
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Corresponding author

Correspondence to Rocco P. Pitto.

Additional information

Best Paper Award, SICOT Annual Conference, Buenos Aires 2006.

This study was supported by an educational grant from the New Zealand Wishbone Trust and was partially funded by DePuy LTD, Leeds, UK.

This study was approved by the local Ethical Board Review Committee.

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Pitto, R.P., Bhargava, A., Pandit, S. et al. Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty. International Orthopaedics (SICO 32, 589–595 (2008). https://doi.org/10.1007/s00264-007-0389-7

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  • DOI: https://doi.org/10.1007/s00264-007-0389-7

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