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Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review

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

Abstract

Introduction

There is a paucity of information on the bone remodeling that occurs distal to the femoral stem following total hip arthroplasty as most previous studies have focused on proximal changes. In this study, we report the cortical thinning that occur distal to the femoral stem after primary total hip arthroplasty.

Methods

A retrospective review was performed at one institution over a 5-year period. 156 primary total hip arthroplasty procedures were included. The Cortical Thickness Index (CTI) was measured on both operative and non-operative hips at 1 cm, 3 cm and 5 cm below the prosthetic stem tip on anteroposterior radiographic images pre-operatively as well as at 6 months, 12 months and 24 months post-operatively. The difference in average CTI was measured using paired t-tests.

Results

There were statistically significant decreases in CTI distal to the femoral stem at 12 months and 24 months (-1.3% and -2.8%, respectively). Greater losses were seen in female patients, patients older than 75, and patients with BMI less than 35 at 6 months postoperative. There were no differences in CTI at any time point on the non-operative side.

Conclusion

The current study demonstrates that patients undergo bone loss as measured by CTI distal to the stem in the first 2 years following total hip arthroplasty. Comparison to the contralateral non-operative side confirms that this change is greater than expected for the natural aging process. A greater understanding of these changes will help optimize post-operative management and direct future innovations in implant design.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Mitchell Messner, Roshan Jacob, Jacob Hagewood, Jackson Broadfoot, Kelly Chandler, Nick Medawar, Sri Prahad & Sameer Naranje

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  1. Mitchell Messner
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Correspondence to Sameer Naranje.

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Messner, M., Jacob, R., Hagewood, J. et al. Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review. Arch Orthop Trauma Surg 143, 6461–6467 (2023). https://doi.org/10.1007/s00402-023-04860-8

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  • DOI: https://doi.org/10.1007/s00402-023-04860-8

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