Abstract
Several factors can cause bone loss and fixation failure following total hip arthroplasty (THA), including polyethylene wear debris, implant micromotion and stress shielding. Various techniques have been used in an effort to detect bone density loss in vivo, all with varying success. Quantitative computed tomography (qCT)-assisted osteodensitometry has been shown to be useful in assessing the in vivo structural bone changes after THA. It has a high resolution, accuracy and reproducibility, thereby making it a useful tool for research purposes, and it is able to differentiate between cortical and cancellous bone structures and assess the bone/implant interface. This technique also provides valuable information about the pattern of stress shielding which occurs around the prosthesis and can show early bony changes, which may prove informative about the quality of implant fixation and surrounding bone adaptation. In conjunction with finite-element analysis, qCT is able to generate accurate patient-specific meshes on which to model implants and their effect on bone remodelling. This technology can be useful to predict bone remodelling and the quality of implant fixation using prostheses with different design and/or biomaterials. In the future, this tool could be used for pre-clinical validation of new implants before their introduction in the market-place.
Résumé
Plusieurs facteurs peuvent causer une perte osseuse et la faillite de la fixation après une arthroplastie totale de la hanche. Ils incluent les débris de polyéthylène, la micromobilité des implants et le transfert de contraintes. Plusieurs techniques ont été utilisées pour détecter la perte de densité osseuse, avec des succés variés. L’ostéodensitométrie quantitative par scanner s’est montrée utile dans l’étude in vivo des modifications structurales osseuses après arthroplastie totale de la hanche. Elle a une haute résolution, une précision et une reproductibilité qui en font un outil approprié pour la recherche. L’ostéodensitométrie quantitative peut différencier l’os cortical et l’os spongieux, étudier l’interface os-implant et donner des informations sur le modèle de déviation des contraintes qui surviennent autour d’une prothèse. Elle peut montrer précocement des modifications osseuses, ce qui renseigne sur la qualité de la fixation des implants et l’adaptation de l’os voisin. En conjonction avec l’analyse par éléments finis elle peut générer un maillage précis spécifique du patient permettant l’étude de modèles d’implants et leur effet sur le remodelage osseux. Cette technologie peut être utile pour prévoir le remodelage osseux et la qualité de la fixation pour des prothèses de différentes formes et/ou matériaux. Dans le future cet outil pourra être utilisé pour la validation pré-clinique de nouveaux implants avant leur introduction sur le marché.
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Pitto, R.P., Mueller, L.A., Reilly, K. et al. Quantitative computer-assisted osteodensitometry in total hip arthroplasty. International Orthopaedics (SICO 31, 431–438 (2007). https://doi.org/10.1007/s00264-006-0257-x
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DOI: https://doi.org/10.1007/s00264-006-0257-x