Maintenance of proximal bone mass with an uncemented femoral stem analysis with dual-energy x-ray absorptiometry

Bone ingrowth into uncemented femoral implants with proximal porous coatings has been designed to avoid proximal stress shielding and preserve femoral strength. Dual-energy x-ray absorptiometry allows repeated quantitative analysis of anteroposterior scans of the proximal femur. By use of dual-energy x-ray absorptiometry and qualitative radiographic changes, 31 total hip arthroplasties with an individually designed, proximally porous-coated prosthesis were evaluated after surgery and at intervals up to 2 years. All implants appeared to achieve successful bone ingrowth and subsequent remodeling. At the most proximal level around the neck osteotomy, the postoperative loss of bone density al 6 months was -14.5%, which persisted at 24 months with -11.6%. At the level of the distal portion of the porous coating in the lower metaphysis, the density change was -8.7%, but bone had remodeled at 24 months with a change in density of only -1.0% compared with the immediate postoperative scan. With a design that results in reliable proximal ingrowth, this study predicts that after an initial decline in bone density, a positive bone remodeling response occurs that could lead to long-term stable fixation of the femoral implant.