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Acetabular cortical and cancellous bone density and radiolucent lines after cemented total hip arthroplasty: a prospective study using computed tomography and plain radiography

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this prospective study was to evaluate load-transfer mechanisms and stress patterns of periacetabular cortical and cancellous bone after cemented total hip arthroplasty (THA) in vivo using computed tomography (CT) assisted osteodensitometry. In addition we analyzed the efficacy of CT in detecting radiolucent lines around the acetabular component compared to plain radiography.

Materials and methods

Twenty-two cemented acetabular cups were investigated using conventional sequential axial CT scans (Ø 8 days and 26 months post-OP) and plain radiography (Ø 5 days and 40 months post-OP). CT assisted osteodensitometry was used to determine cancellous and cortical bone bone density (BD). Radiolucent lines were evaluated using both CT and plain radiography.

Results

Significant BD loss at the time of follow-up was only detectable ventral to the cup (cortical bone: −16%, P = 0.001; cancellous bone: −31%, P = 0.001). The BD changes dorsal and cranial to the cup were not significant. Postoperatively no radiolucent lines were observed in the cement-bone interface by CT, while on plain radiography acetabular lucent lines were seen in 12 out of 22 cases.

Conclusion

CT-osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling: sufficient cancellous and cortical bone stock remained dorsal and cranial to the cup indicative of a balanced load transfer to these regions. CT-osteodensitometry has the potential to become an effective instrument for quality control in THA and the method of choice for in vivo determination of periprosthetic BD. In contrast, plain radiography is more suitable for the early detection of radiolucent lines compared to axial CT scans.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Am Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen, Germany

    Lutz Arne Mueller, Rainer Schmidt, Cornelia Ehrmann, Raimund Forst & Stefan Eichinger

  2. Department of Trauma Surgery, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany

    Tobias Eckhard Nowak & Lars Peter Mueller

  3. Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Auckland, New Zealand

    Rocco Paolo Pitto

  4. Orthopaedics II, Medical Park Bad Rodach, Kurring 16, 96476, Bad Rodach, Germany

    David Pfander

Authors
  1. Lutz Arne Mueller
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  2. Tobias Eckhard Nowak
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  3. Lars Peter Mueller
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  4. Rainer Schmidt
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  5. Cornelia Ehrmann
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  6. Rocco Paolo Pitto
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  7. David Pfander
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  8. Raimund Forst
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  9. Stefan Eichinger
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Corresponding author

Correspondence to Lutz Arne Mueller.

Additional information

Lutz Arne Mueller and Tobias Eckhard Nowak contributed equally to this paper.

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Mueller, L.A., Nowak, T.E., Mueller, L.P. et al. Acetabular cortical and cancellous bone density and radiolucent lines after cemented total hip arthroplasty: a prospective study using computed tomography and plain radiography. Arch Orthop Trauma Surg 127, 909–917 (2007). https://doi.org/10.1007/s00402-007-0304-0

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