Artikel
Periprosthetic bone remodelling around uncemented titanium stems in the second and third decade after total hip arthroplasty: a DXA study after 12, 17 and 21 years
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Veröffentlicht: | 6. November 2018 |
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Objectives: Promising long-term results were shown for straight titanium uncemented stems in terms of fixation into the third decade postoperatively. Periprosthetic loss of BMD is considered an important issue in the long-term, but little is known about its extent into the third decade.
The aim of this study is to evaluate whether relevant bone loss continues into the late second and early third decade around well-fixed uncemented femoral implants.
Methods: Periprosthetic BMD was measured using the Dual Energy X-Ray Absorptiometry (DXA). We prospectively included 146 hips in 131 patients. The baseline measurement was 12 years (t1) after the implantation of an uncemented CLS-Spotorno stem. Follow-up measurements were performed at 17 (t2) and at 21 years (t3) after primary THA. The regions of interest (ROI) were selected conforming to Gruen et al.
Results and conclusion: We acquired complete data including three subsequent measurements (t1, t2, t3) for 44 patients (51 hips). Performing radiographic evaluation at t1, t2 and t3 we found a regular bone-implant interface present in all cases. Significant decrease in BMD could be shown in ROI 1, 4, 6 and 7 in the total cohort, in ROI 1 and 7 in male and in ROI 1, 6 and 7 in female patients between t1 and t3. In the total cohort there was also a significant reduction in BMD in ROI 1, 4 and 7 between t2 and t3. For the same interval significant changes were found in ROI 1, 4 and 7 in female and none in male patients. There was no significant difference in overall bone density (netavg) between t1 and t3 and between t2 and t3.
The data indicate clinically relevant changes of BMD in the proximal Gruen zones in the long-term after uncemented THA. Loss of periprosthetic BMD might be a risk factor for periprosthetic fractures.