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Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review

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Abstract

Purpose

Short-stem hip arthroplasty (SHA) was designed to preserve bone stock and provide an improved load transfer. To gain more evidence regarding the load transfer, this review analysed the periprosthetic bone remodelling of SHA in comparison to standard hip arthroplasty (THA).

Methods

PubMed and ScienceDirect were screened to extract dual-energy X-ray absorptiometry (DXA) studies evaluating the periprosthetic bone remodelling of SHA and two proven THA designs. From the studies included, the postoperative change in periprosthetic bone mineral density (BMD) after one year and the trend over two years was determined.

Results

Fifteen studies with four SHAs (CFP, Metha, Nanos, Fitmore) and two THAs (CLS and Bicontact) designs were included. All SHA and THA stems revealed an initial decrease at the calcar and major trochanter (Gruen 1 and 7) with the Metha, Nanos and Fitmore showing a smaller and more balanced remodelling compared to THA. The pattern after one year and the trend over two years argue for a methaphyseal anchorage of the Metha and Nanos, whereas the Fitmore and CFP seem to anchor metha-diaphyseal. Clearly different pattern of bone remodelling were observed between all four SHAs.

Conclusions

Periprosthetic bone remodelling is also present in SHA, with the main bone reduction observed proximally. However, certain SHA stems show a more balanced remodelling compared to THA, arguing for a favourable load transfer. Also, the femoral length where bone remodelling occurs is clearly shorter in SHA. As distinctively different pattern between the SHA designs were observed, they should not be judged as a single implant group.

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Acknowledgements

This study includes parts of the thesis of Y.S.G.

Funding

There was no funding source.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany

    Shuang G. Yan, Patrick Weber, Arnd Steinbrück, Volkmar Jansson & Florian Schmidutz

  2. The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China

    Shuang G. Yan & Xingyi Hua

  3. BG Trauma Centre Tübingen, University of Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany

    Florian Schmidutz

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  1. Shuang G. Yan
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  2. Patrick Weber
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  3. Arnd Steinbrück
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  6. Florian Schmidutz
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Correspondence to Florian Schmidutz.

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The authors declare that they have no conflict of interest.

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This systematic review retrospectively analysed published clinical data wherefore upon request of the Ethics Committee (Ethical Committee University of the LMU) neither a special ethics review nor a further ethical approval was necessary.

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Due to the retrospective nature using anonymous data no additional informed consent of the patients was necessary.

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Yan, S.G., Weber, P., Steinbrück, A. et al. Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. International Orthopaedics (SICOT) 42, 2077–2086 (2018). https://doi.org/10.1007/s00264-017-3691-z

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  • DOI: https://doi.org/10.1007/s00264-017-3691-z

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