Periprosthetic bone loss after insertion of an uncemented, customized femoral stem and an uncemented anatomical stem A randomized DXA study with 5-year follow-up

被引:29
作者
Nysted, Mona [1 ]
Benum, Pal [1 ,2 ]
Klaksvik, Jomar [1 ]
Foss, Olav [1 ]
Aamodt, Arild [1 ,2 ]
机构
[1] Norwegian Univ Sci & Technol, Univ Trondheim Hosp, Dept Orthopaed Surg, N-7034 Trondheim, Norway
[2] Norwegian Univ Sci & Technol, Dept Neurosci, N-7034 Trondheim, Norway
关键词
TOTAL HIP-ARTHROPLASTY; X-RAY ABSORPTIOMETRY; MINERAL DENSITY; DESIGN; IMPLANT; PROSTHESIS; DEXA; DENSITOMETRY; RESORPTION; STANDARD;
D O I
10.3109/17453674.2011.588860
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background and purpose Customized femoral stems are designed to have a perfect fit and fill in the femur in order to achieve physiological load transfer and minimize stress shielding. Dual-energy X-ray absorptiometry (DXA) is regarded as an accurate method for detection of small alterations in bone mineral density (BMD) around hip prostheses. We present medium-term DXA results from a randomized study comparing a customized and an anatomical femoral stem. Methods 100 hips were randomized to receive either the anatomical ABG-I stem or the Unique customized femoral stem, both uncemented. DXA measurements were conducted postoperatively and after 3, 6, 12, 24, 36, and 60 months, and BMD was computed for each of the 7 Gruen zones in the proximal femur. Results Results from 87 patients were available for analysis. 78 completed the 5-year follow-up: 35 patients in the ABG group and 43 patients in the Unique group. In both groups, we found the greatest degree of bone loss in the proximal Gruen zones. In zone 1, there was 15% reduction in BMD in the ABG-I group and 14% reduction in the Unique group. In zone 7, the reduction was 28% in the ABG-I group and 27% in the Unique group. The only statistically significant difference between the groups was found in Gruen zone 4, which is distal to the tip of the stem, with 1.6% reduction in BMD in the ABG-I group and 9.7% reduction in the Unique group (p = 0.003). Interpretation 5-year DXA results showed that because of stress-shielding, proximal bone loss could not be avoided-either for the anatomical ABG-I stem or for the customized Unique stem.
引用
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页码:410 / 416
页数:7
相关论文
共 39 条
[11]  
Engh CA, 1999, J ARTHROPLASTY, V14, P637
[12]   Medium-term results of the ABG total hip arthroplasty in young patients [J].
Giannikas, KA ;
Din, R ;
Sadiq, S ;
Dunningham, TH .
JOURNAL OF ARTHROPLASTY, 2002, 17 (02) :184-188
[13]   Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem - A randomized study with use of radio stereometry and bone densitometry [J].
Grant, P ;
Aamodt, A ;
Falch, JA ;
Nordsletten, L .
JOURNAL OF ORTHOPAEDIC RESEARCH, 2005, 23 (06) :1280-1285
[14]   Seven to 10 years followup of an anatomic hip prosthesis -: An international study [J].
Herrera, A ;
Canales, V ;
Anderson, J ;
García-Araujo, C ;
Murcia-Mazón, A ;
Tonino, AJ .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2004, (423) :129-137
[15]   Comparison Between DEXA and Finite Element Studies in the Long-Term Bone Remodeling of an Anatomical Femoral Stem [J].
Herrera, A. ;
Panisello, J. J. ;
Ibarz, E. ;
Cegonino, J. ;
Puertolas, J. A. ;
Gracia, L. .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 2009, 131 (04)
[16]  
HUISKES R, 1992, CLIN ORTHOP RELAT R, P124
[17]  
HUISKES R, 1989, ORTHOPEDICS, V12, P1255
[18]  
Karrholm J, 2002, J BONE JOINT SURG AM, V84A, P1651
[19]  
Kiratli BJ, 1996, J ARTHROPLASTY, V11, P184
[20]   DETERMINATION OF BONE-MINERAL DENSITY BY DUAL X-RAY ABSORPTIOMETRY IN PATIENTS WITH UNCEMENTED TOTAL HIP-ARTHROPLASTY [J].
KIRATLI, BJ ;
HEINER, JP ;
MCBEATH, AA ;
WILSON, MA .
JOURNAL OF ORTHOPAEDIC RESEARCH, 1992, 10 (06) :836-844