Skip to main content

Advertisement

SpringerLink
Log in

Early periprosthetic bone remodelling around cemented and uncemented custom-made femoral components and their uncemented acetabular cups

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

Abstract

Introduction

Periprosthetic bone remodelling after total hip replacement may contribute to aseptic loosening of the prosthesis. The selection between cemented and uncemented fixation of the stem is mainly determined by patient’s age, general constitution and CT scan-estimated bone quality; intra-operative observation may ultimately influence the choice of the fixation method. The influence of cemented versus uncemented stem fixation on periprosthetic bone remodelling around the uncemented cup has, to our knowledge, never been studied until now.

Methods

A total of 75 patients received intra-operatively manufactured stem prostheses and a standard hydroxy apatite-coated pinnacle cup. The pre-operative CT scans provides guidance for the bone quality and hence the type of stem fixation: cemented or uncemented. The influence of either type of stem fixation on periprosthetic bone remodelling around the cup and the stem was measured by bone mineral density at 6 weeks, and 3, 6 and 12 months after surgery.

Results

Early changes in bone mineral density were noted. The type of stem fixation had an influence on the bone remodelling of the femur and also of the pelvis. The caudal part of the acetabulum was subject to a greater loss in BMD at 12 months in the group with cemented stem fixation. Changes at 12 months correlated with the changes measured at any time point.

Conclusions

The selection of the stem implant and its type of fixation in the femoral cavity (cemented or uncemented fixation) seems to have an impact on the bone mineral density of the acetabulum. Long-term clinical follow-up is required to draw conclusions regarding the influence on prosthesis survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lucht U (2000) The Danish Hip Arthroplasty Register. Acta Orthop Scand 71(5):433–439

    Article  PubMed  CAS  Google Scholar 

  2. Britton AR, Murray DW, Bulstrode CJ, McPherson K, Denham RA (1996) Long-term comparison of Charnley and Stanmore design total hip replacements. J Bone Joint Surg Br 78(5):802–808

    PubMed  CAS  Google Scholar 

  3. Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, Kainberger F, Gottsauner-Wolf F (2004) Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. A five-year longitudinal study. J Bone Joint Surg Br 86(1):20–26

    PubMed  CAS  Google Scholar 

  4. Karrholm J, Anderberg C, Snorrason F, Thanner J, Langeland N, Malchau H, Herberts P (2002) Evaluation of a femoral stem with reduced stiffness. A randomized study with use of radiostereometry and bone densitometry. J Bone Joint Surg Am 84-A(9):1651–1658

    PubMed  Google Scholar 

  5. Maloney WJ, Sychterz C, Bragdon C, McGovern T, Jasty M, Engh CA, Harris WH (1996) The Otto Aufranc Award. Skeletal response to well fixed femoral components inserted with and without cement. Clin Orthop Relat Res 333:15–26

  6. Ramaniraka NA, Rakotomanana LR, Rubin PJ, Leyvraz P (2000) Noncemented total hip arthroplasty: influence of extramedullary parameters on initial implant stability and on bone–implant interface stresses. Rev Chir Orthop Reparatrice Appar Mot 86(6):590–597

    PubMed  CAS  Google Scholar 

  7. Mallory TH, Head WC, Lombardi AV Jr (1997) Tapered design for the cementless total hip arthroplasty femoral component. Clin Orthop Relat Res 344:172–178

    Article  PubMed  Google Scholar 

  8. Mulier JC, Mulier M, Brady LP, Steenhoudt H, Cauwe Y, Goossens M, Elloy M (1989) A new system to produce intraoperatively custom femoral prosthesis from measurements taken during the surgical procedure. Clin Orthop Relat Res 249:97–112

    PubMed  Google Scholar 

  9. Leichtle UG, Leichtle CI, Schmidt B, Martini F (2006) Peri-prosthetic bone density after implantation of a custom-made femoral component. A five-year follow-up. J Bone Joint Surg Br 88(4):467–471

    Article  PubMed  CAS  Google Scholar 

  10. Levenston ME, Beaupre GS, Schurman DJ, Carter DR (1993) Computer simulations of stress-related bone remodeling around noncemented acetabular components. J Arthroplasty 8(6):595–605

    Article  PubMed  CAS  Google Scholar 

  11. Field RE, Cronin MD, Singh PJ, Burtenshaw C, Rushton N (2006) Bone remodelling around the Cambridge cup: a DEXA study of 50 hips over 2 years. Acta Orthop 77(5):726–732

    Article  PubMed  Google Scholar 

  12. Shetty NR, Hamer AJ, Kerry RM, Stockley I, Eastell R, Wilkinson JM (2006) Bone remodelling around a cemented polyethylene cup. A longitudinal densitometry study. J Bone Joint Surg Br 88(4):455–459

    Article  PubMed  CAS  Google Scholar 

  13. Laursen MB, Nielsen PT, Soballe K (2006) Bone remodelling around HA-coated acetabular cups: a DEXA study with a 3-year follow-up in a randomised trial. Int Orthop 31:199–204

    Article  PubMed  Google Scholar 

  14. Sabo D, Reiter A, Simank HG, Thomsen M, Lukoschek M, Ewerbeck V (1998) Periprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno stem with DEXA. Calcif Tissue Int 62(2):177–182

    Article  PubMed  CAS  Google Scholar 

  15. Wilkinson JM, Eagleton AC, Stockley I, Peel NF, Hamer AJ, Eastell R (2005) Effect of pamidronate on bone turnover and implant migration after total hip arthroplasty: a randomized trial. J Orthop Res 23(1):1–8

    Article  PubMed  CAS  Google Scholar 

  16. Kim YH, Yoon SH, Kim JS (2007) Changes in the bone mineral density in the acetabulum and proximal femur after cementless total hip replacement: alumina-on-alumina versus alumina-on-polyethylene articulation. J Bone Joint Surg Br 89(2):174–179

    Article  PubMed  Google Scholar 

  17. Wilkinson JM, Hamer AJ, Rogers A, Stockley I, Eastell R (2003) Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty. J Orthop Res 21(4):691–696

    Article  PubMed  CAS  Google Scholar 

  18. Dan D, Germann D, Burki H, Hausner P, Kappeler U, Meyer RP, Klaghofer R, Stoll T (2006) Bone loss after total hip arthroplasty. Rheumatol Int 26(9):792–798

    Article  PubMed  Google Scholar 

  19. Digas G, Karrholm J, Thanner J (2006) Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: repeated DXA studies in 96 hips randomized to 3 types of fixation. Acta Orthop 77(2):218–226

    Article  PubMed  Google Scholar 

  20. Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br 83(2):283–288

    Article  PubMed  CAS  Google Scholar 

  21. Abrahamsen B, Tofteng CL, Barenholdt O, Vestergaard P, Stilgren LS, Beck-Nielsen H, Nielsen SP, Sorensen OH, Mosekilde L (2003) Standardization of BMD T-Scores in the first five years after the menopause: do femoral neck-equivalent and older normative range T-Scores improve diagnostic agreement? J Clin Densitom 6(2):87–95

    Article  PubMed  Google Scholar 

  22. Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  23. Manley MT, Ong KL, Kurtz SM (2006) The potential for bone loss in acetabular structures following THA. Clin Orthop Relat Res 453:246–253

    Article  PubMed  Google Scholar 

  24. Takagi M (2001) Bone–implant interface biology: foreign body reaction and periprosthetic osteolysis in artificial hip joints. J Clin Exp Hematopathol 41(2):81–87

    Article  Google Scholar 

  25. Wright JM, Pellicci PM, Salvati EA, Ghelman B, Roberts MM, Koh JL (2001) Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography. J Bone Joint Surg Am 83(4):529–536

    PubMed  Google Scholar 

  26. Yamaguchi K, Masuhara K, Ohzono K, Sugano N, Nishii T, Ochi T (2000) Evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. The influence of the extent of porous coating. J Bone Joint Surg Am 82(10):1426–1431

    PubMed  Google Scholar 

  27. Rahmy AI, Gosens T, Blake GM, Tonino A, Fogelman I (2004) 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. Osteoporos Int 15(4):281–289

    Article  PubMed  CAS  Google Scholar 

  28. Pritchett JW (1995) Femoral bone loss following hip replacement. A comparative study. Clin Orthop Relat Res 314:156–161

    PubMed  Google Scholar 

  29. Parker MJ, Gurusamy K (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 3(3):CD001706

    Google Scholar 

  30. Sanfilippo JA, Austin MS (2006) Implants for total hip arthroplasty. Expert Rev Med Devices 3(6):769–776

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University Hospital Leuven, K.U. Leuven, Campus Pellenberg, Weligerveld 1, 3212, Lubbeek, Belgium

    M. Mulier, M. Raaijmaakers & J. Nijs

  2. Department of Dentistry, Oral Pathology and Maxillofacial Surgery, BIOMAT Research Cluster, K.U. Leuven, Leuven, Belgium

    S. V. N. Jaecques

  3. Division of Biomechanics and Engineering Design (BMGO), Leuven, Belgium

    S. V. N. Jaecques, J. Nijs & G. Van der Perre

  4. Department of Biomedical Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium

    I. Jonkers

Authors
  1. M. Mulier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. V. N. Jaecques
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Raaijmaakers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Nijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Van der Perre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. Jonkers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Mulier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mulier, M., Jaecques, S.V.N., Raaijmaakers, M. et al. Early periprosthetic bone remodelling around cemented and uncemented custom-made femoral components and their uncemented acetabular cups. Arch Orthop Trauma Surg 131, 941–948 (2011). https://doi.org/10.1007/s00402-010-1239-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-010-1239-4

Keywords

Search

Navigation