1
|
Influence of Hydroxyapatite Coating for the Prevention of Bone Mineral Density Loss and Bone Metabolism after Total Hip Arthroplasty: Assessment Using 18F-Fluoride Positron Emission Tomography and Dual-Energy X-Ray Absorptiometry by Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4154290. [PMID: 32185203 PMCID: PMC7060431 DOI: 10.1155/2020/4154290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Background Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.
Collapse
|
2
|
Is there any difference between tapered titanium stems with similar geometry and hydroxyapatite coating? Musculoskelet Surg 2019; 103:275-281. [PMID: 30617813 DOI: 10.1007/s12306-018-00586-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Several tapered stems with similar geometry and extensive hydroxyapatite coating have recently been introduced. It is not clear, however, whether they share the same design or whether they exhibit any difference that might affect their clinical performances. In this study, we analysed five tapered stems fully coated with hydroxyapatite to establish whether they exhibit similar geometric features and may therefore be used indifferently when a cementless stem is indicated. METHODS The length of the stem, the coronal and sagittal diameters, the length of the stem shoulder and the metadiaphyseal angle were measured. The ratio between the proximal and distal coronal diameters of the stem and that between the proximal and distal cross-sectional areas were calculated as a flare index and tapered index, respectively. RESULTS The proximal coronal diameter ranged between 24.9 and 28 mm in the smaller size and between 34 and 38.4 mm in the largest sizes. The proximal sagittal diameter ranged between 10.2 and 11.8 in the smallest size and between 14.4 and 17.2 in the largest. A significant difference was found between stems of different brands in the flare index, tapered index, length of stem shoulder and metadiaphyseal angle. CONCLUSIONS Lookalike tapered stems with extensive HA coating actually exhibit significant differences in several geometric features potentially affecting their clinical performances. As a result, these stems should not be used indifferently, but rather they should be selected on the basis of the femoral morphology of the operated patient.
Collapse
|
3
|
Lerch M, Windhagen H, Kurtz AE, Budde S, Behrens BA, Bouguecha A, Almohallami A. 'Pre-launch' finite element analysis of a short-stem total hip arthroplasty system consisting of two implant types. Clin Biomech (Bristol, Avon) 2019; 61:31-37. [PMID: 30458330 DOI: 10.1016/j.clinbiomech.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We applied a previously established and validated numerical model to a novel short-stemmed implant for a 'pre-launch' investigation. METHODS The implant system consists of two different implant geometries for valgus/varus-positioned proximal femurs with differences in volume distribution, head/neck angle, and calcar alignment. The aim of the design was to achieve a better adaption to the anatomic conditions, resulting in a favourable load transfer. The implant type G showed the best fit to our model, but both stem geometries were implanted; the implant type B was used to compute an 'imperfection scenario'. FINDINGS Apparent bone density decreased by 4.3% in the entire femur with the implant type G, and by 12.3% with the implant type B. Bone mass loss was pronounced in the proximal calcar region. Apparent bone density increased at the lateral cortical ring and in the minor trochanter. The apparent bone density in the imperfection scenario was very similar to that of a straight stem, indicating a distal load transfer. INTERPRETATION No adverse effects of the A2 short-stemmed implant system on bone remodeling could be detected. The overall bone density reduction was acceptable, and wedge fixation was not observed, indicating that there was no distal load transfer. The simulation of an incongruous implant indicates the sensitivity of our model in response to modifications of implant positioning. Correct implant selection and positioning is crucial when using the A2 system.
Collapse
Affiliation(s)
- Matthias Lerch
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries Straße 1-7, 30625 Hannover, Germany.
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries Straße 1-7, 30625 Hannover, Germany.
| | - Agnes-Elisabeth Kurtz
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries Straße 1-7, 30625 Hannover, Germany.
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries Straße 1-7, 30625 Hannover, Germany.
| | - Bernd-Arno Behrens
- Institute of Forming Technology and Machines, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Germany.
| | - Anas Bouguecha
- Institute of Forming Technology and Machines, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Germany; Laboratory La2MP, ENIS, National school of engineering in Gafsa, Sfax, Tunisia
| | - Amer Almohallami
- Institute of Forming Technology and Machines, Leibniz University Hannover, An der Universität 2, 30823 Garbsen, Germany; PROFIL Verbindungstechnik GmbH & Co. KG, Otto-Hahn-Strasse 22-24, 61381 Friedrichsdorf, Germany
| |
Collapse
|
4
|
Bone mineral density as a marker of hip implant longevity: a prospective assessment of a cementless stem with dual-energy X-ray absorptiometry at twenty years. INTERNATIONAL ORTHOPAEDICS 2018; 43:71-75. [DOI: 10.1007/s00264-018-4187-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
|
5
|
Yan SG, Li D, Yin S, Hua X, Tang J, Schmidutz F. Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty: A systematic review and meta-analysis of randomized-controlled trials. Medicine (Baltimore) 2017; 96:e8806. [PMID: 29381984 PMCID: PMC5708983 DOI: 10.1097/md.0000000000008806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Short-stem total hip arthroplasty (SHA) has been increasingly used in the treatment of hip arthroplasty. However, it is unclear whether there is a superiority of SHA in periprosthetic bone remodeling over standard stem total hip arthroplasty (THA). This meta-analysis of randomized-controlled trials (RCTs) compared the periprosthetic bone remodeling after SHA and THA. METHODS PubMed and Embase were screened for relevant publications up to May 2017. RCTs that compared periprosthetic bone remodeling with bone mineral density (BMD) changes between SHA and THA were included. Meta-analysis was conducted to calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs) using Stata version 12.0. Quality appraisal was performed by 2 independent reviewers using RevMan 5.3 software and Grades of Recommendation Assessment, Development, and Evaluation criteria. RESULTS Seven studies involving 910 patients and 5 SHA designs (Proxima, Fitmore, Microplasty short, Unique custom, and Omnifit-HA 1017) were included for meta-analysis. The pooled data showed no significant differences in the percentage BMD changes in all Gruen zones, with Gruen zone 1 [mean difference (MD) = 11.33, 95% CI, -1.67 to 24.33; P = .09] and Gruen zone 7 (MD = 8.46, 95% CI, -1.73 to 18.65; P = .10). Subgroup analysis of short SHA stems with lateral flare showed a significant less percentage BMD changes compared with standard THA in Gruen zone 1 (MD = 27.57, 95% CI, 18.03-37.12; P < .0001) and Gruen zone 7 (MD = 18.54, 95% CI, 8.27-28.81; P < .0001). CONCLUSION The study shows moderate-quality evidence that periprosthetic bone remodeling around the analyzed SHA stems was similar to standard THA stems. However, short SHA stems with lateral flare revealed a moderate- to low-quality evidence for superiority over the standard THA and highlighted the importance of the different SHA designs. Besides, it has to be noticed that despite a similar pattern of periprosthetic bone remodeling, the femoral length where periprosthetic bone remodeling occurs is clearly shorter in SHA. Due to the moderate- to low-quality evidence and the limited stem designs analyzed, the further large-scale multicenter RCTs including the most recent SHA designs are required. However, the current findings should be considered by surgeons for counseling patients regarding total hip replacement.
Collapse
Affiliation(s)
- Shuang G Yan
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany Department of Orthopedic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei Department of Orthopedic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China BG Trauma Center, Eberhard Karls University Tübingen, Tuebingen, Germany
| | | | | | | | | | | |
Collapse
|
6
|
Koyano G, Jinno T, Koga D, Yamauchi Y, Muneta T, Okawa A. Comparison of Bone Remodeling Between an Anatomic Short Stem and a Straight Stem in 1-Stage Bilateral Total Hip Arthroplasty. J Arthroplasty 2017; 32:594-600. [PMID: 27554784 DOI: 10.1016/j.arth.2016.07.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Femurs of dysplastic hips exhibit specific abnormalities, and use of modular or specially designed components is recommended. An anatomic short stem was previously designed specifically for dysplastic hips using 3-dimensional data acquired from dysplastic patients. To investigate effects of stem geometry on bone remodeling, we undertook a prospective, randomized study of patients who had undergone 1-stage bilateral total hip arthroplasty (THA) with the anatomic short stem on one side and a conventional straight stem on the other. METHODS The study included 36 patients who underwent the above THA procedure. We assessed bone mineral density as well as the presence of cancellous condensation or bony atrophy due to stress shielding based on the analysis of Gruen's zones and newly defined equal-interval zones, at an average follow-up period of 9.2 years. RESULTS All stems were bone ingrown stable. Cancellous condensation was observed more proximally, and areas of bone atrophy were narrower on the anatomic short stem side than on the straight stem side. Bone mineral density values reflected results of cancellous condensation and stress shielding and were higher in more proximal zones on the anatomic short stem side than on the straight stem side. CONCLUSION Although radiographic results indicated good midterm outcomes of THA with both stems, the loading pattern differed. The anatomic short stem achieved its design purpose in terms of proximal fixation and load transfer and led to better preservation of the proximal femur.
Collapse
Affiliation(s)
- Gaku Koyano
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Yamauchi
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
7
|
Matsuyama K, Ishidou Y, Guo YM, Kakoi H, Setoguchi T, Nagano S, Kawamura I, Maeda S, Komiya S. Finite element analysis of cementless femoral stems based on mid- and long-term radiological evaluation. BMC Musculoskelet Disord 2016; 17:397. [PMID: 27642748 PMCID: PMC5028915 DOI: 10.1186/s12891-016-1260-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoral bone remodeling in response to stress shielding induces periprosthetic bone loss. Computerized finite element analysis (FEA) is employed to demonstrate differences in initial stress distribution. However, FEA is often performed without considering the precise sites at which the stem was fixed. We determined whether FEA reflects mid-term radiological examination exactly as predicted following long-term stress shielding. METHODS Femur-stem fixation sites were evaluated radiologically according to the location of spot welds in two anatomical cementless stem designs. Based on mid-term radiological results, four femur-stem bonding site conditions were defined as: (Condition A) no bonding; (Condition B) bonding within the 10 mm area proximal to the distal border of the porous area; (Condition C) bonding of the entire porous area; and (Condition D) bonding of the entire femoral stem, prior to conducting FEA analysis. Furthermore, we radiographically evaluated mid- and long-term stress shielding, and measured bone mineral density of the femur 10 years after total hip arthroplasty. RESULTS Spot welds appeared frequently around the border between the porous and smooth areas. FEA showed that, based on mid-term radiological evaluation, von Mises stress was reduced in condition B in the area proximal to the femur-stem bonding sites for both stem designs compared with condition A (no bonding). Conversely, von Mises stress at all areas of the femur-stem bonding sites in conditions C and D was higher than that in condition A. With respect to stress shielding progression, there was no significant difference between the two types of stem designs. However, stress shielding progressed and was significantly higher in the presence of spot welds (p = 0.001). In both stem designs, bone mineral density in zone VII was significantly lower than that in the contralateral hips. CONCLUSIONS These results indicate that FEA based on mid-term radiological evaluation may be helpful to predict the influence of long-term stress shielding more precisely.
Collapse
Affiliation(s)
- Kanehiro Matsuyama
- Department of Medical Joint Materials, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yasuhiro Ishidou
- Department of Medical Joint Materials, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Yong-Ming Guo
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Kagoshima University, Kagoshima, Japan
| | - Hironori Kakoi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Ichiro Kawamura
- Department of Medical Joint Materials, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shingo Maeda
- Department of Medical Joint Materials, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Setsuro Komiya
- Department of Medical Joint Materials, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan.,The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
8
|
Long-term response of femoral density to hip implant and bone fracture plate: Computational study using a mechano-biochemical model. Med Eng Phys 2016; 38:171-80. [PMID: 26751582 DOI: 10.1016/j.medengphy.2015.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 10/26/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
Although bone fracture plates can provide appropriate stability at the fracture site and lead to early patient mobilization, they significantly change the loading pattern in the bone after union (Stress shielding). This phenomenon results in a bone density decrease, which may cause premature failure of the implant. This paper presents the first study that quantifies the long-term response of femoral density to hip implantation and plating (lateral and anterior plating) using a mechano-biochemical model which considers the coupling effect between mechanical loading and biochemical affinities as stimuli for bone remodeling. The results showed that the regions directly beneath the plate experienced severe bone loss (i.e. up to ∼ -70%). However, some level of bone formation was observed in the vicinity of the most proximal and distal screw holes in both lateral and anterior plated femurs (i.e. up to ∼ +110%). The bone under the plate was divided into six zones. With respect to bone remodeling response, the findings revealed that anterior plating was not superior to lateral plating since the maximum and average bone losses among the zones in the anterior plated femur (i.e. -36% and -24%, respectively) were approximately the same as their corresponding values in the lateral plated femur (i.e. -38% and -24%, respectively).
Collapse
|
9
|
Kobayashi N, Inaba Y, Uchiyama M, Ike H, Kubota S, Saito T. Teriparatide Versus Alendronate for the Preservation of Bone Mineral Density After Total Hip Arthroplasty - A randomized Controlled Trial. J Arthroplasty 2016; 31:333-8. [PMID: 26260784 DOI: 10.1016/j.arth.2015.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 02/01/2023] Open
Abstract
In this study, the effect of teriparatide for the prevention of bone mineral density (BMD) loss after THA was compared with alendronate in a randomized controlled trial. Forty-eight patients were assigned to three groups, namely, the teriparatide, alendronate, and no medication groups. Dual-energy x-ray absorptiometry (DEXA) was performed at 1 week post-surgery as a baseline reference, followed by subsequent measurements at 12, 24, and 48 weeks postoperatively. For periprosthetic BMD loss, a significant effect of teriparatide was demonstrated, though its effect was similar to alendronate. On the other hand, higher lumbar BMD was observed in the teriparatide group than in the alendronate group at 48 weeks post-surgery. Teriparatide administration may be one reasonable option for osteoporotic patient to preserve the periprosthetic BMD after THA.
Collapse
Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Makoto Uchiyama
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - So Kubota
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| |
Collapse
|
10
|
Miyatake K, Jinno T, Koga D, Yamauchi Y, Muneta T, Okawa A. Comparison of Different Materials and Proximal Coatings Used for Femoral Components in One-Stage Bilateral Total Hip Arthroplasty. J Arthroplasty 2015; 30:2237-41. [PMID: 26190568 DOI: 10.1016/j.arth.2015.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 06/10/2015] [Indexed: 02/01/2023] Open
Abstract
To evaluate the mid-term effects of different materials and coatings used for femoral components, we prospectively performed 21 one-stage bilateral total hip arthroplasties using 2 anatomical stems which have identical geometries, randomized to side. One stem was made of Ti6Al4V alloy and had a hydroxyapatite coating on grit-blasted surface proximally, and the other was made of TMZF™ alloy and had a proximal coating of hydroxyapatite in addition to an arc-deposited titanium surface coating. Although we found extensions of radiopaque lines to the surface of coatings of seven grit-blasted stems whereas we found none in the case of the arc-deposited titanium stems, all hips showed excellent clinical and radiological outcomes as shown by radiographs and bone mineral density at the final follow-up, average 5.5 years postoperatively.
Collapse
Affiliation(s)
- Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Yamauchi
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
11
|
Does hydroxyapatite coating have no advantage over porous coating in primary total hip arthroplasty? A meta-analysis. J Orthop Surg Res 2015; 10:21. [PMID: 25626520 PMCID: PMC4314743 DOI: 10.1186/s13018-015-0161-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/08/2015] [Indexed: 11/18/2022] Open
Abstract
There are some arguments between the use of hydroxyapatite and porous coating. Some studies have shown that there is no difference between these two coatings in total hip arthroplasty (THA), while several other studies have shown that hydroxyapatite has advantages over the porous one. We have collected the studies in Pubmed, MEDLINE, EMBASE, and the Cochrane library from the earliest possible years to present, with the search strategy of “(HA OR hydroxyapatite) AND ((total hip arthroplasty) OR (total hip replacement)) AND (RCT* OR randomiz* OR control* OR compar* OR trial*)”. The randomized controlled trials and comparative observation trials that evaluated the clinical and radiographic effects between hydroxyapatite coating and porous coating were included. Our main outcome measurements were Harris hip score (HHS) and survival, while the secondary outcome measurements were osteolysis, radiolucent lines, and polyethylene wear. Twelve RCTs and 9 comparative observation trials were included. Hydroxyapatite coating could improve the HHS (p < 0.01), reduce the incidence of thigh pain (p = 0.01), and reduce the incidence of femoral osteolysis (p = 0.01), but hydroxyapatite coating had no advantages on survival (p = 0.32), polyethylene wear (p = 0.08), and radiolucent lines (p = 0.78). Hydroxyapatite coating has shown to have an advantage over porous coating. The HHS and survival was duration-dependent—if given the sufficient duration of follow-up, hydroxyapatite coating would be better than porous coating for the survival. The properties of hydroxyapatite and the implant design had influence on thigh pain incidence, femoral osteolysis, and polyethylene wear. Thickness of 50 to 80 μm and purity larger than 90% increased the thigh pain incidence. Anatomic design had less polyethylene wear.
Collapse
|
12
|
Tavakkoli Avval P, Klika V, Bougherara H. Predicting Bone Remodeling in Response to Total Hip Arthroplasty: Computational Study Using Mechanobiochemical Model. J Biomech Eng 2014; 136:051002. [DOI: 10.1115/1.4026642] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/06/2014] [Indexed: 11/08/2022]
Abstract
Periprosthetic bone loss following total hip arthroplasty (THA) is a serious concern leading to the premature failure of prosthetic implant. Therefore, investigating bone remodeling in response to hip arthroplasty is of paramount for the purpose of designing long lasting prostheses. In this study, a thermodynamic-based theory, which considers the coupling between the mechanical loading and biochemical affinity as stimulus for bone formation and resorption, was used to simulate the femoral density change in response to THA. The results of the numerical simulations using 3D finite element analysis revealed that in Gruen zone 7, after remarkable postoperative bone loss, the bone density started recovering and got stabilized after 9% increase. The most significant periprosthetic bone loss was found in Gruen zone 7 (−17.93%) followed by zone 1 (−13.77%). Conversely, in zone 4, bone densification was observed (+4.63%). The results have also shown that the bone density loss in the posterior region of the proximal metaphysis was greater than that in the anterior side. This study provided a quantitative figure for monitoring the distribution variation of density throughout the femoral bone. The predicted bone density distribution before and after THA agree well with the bone morphology and previous results from the literature.
Collapse
Affiliation(s)
- Pouria Tavakkoli Avval
- Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada e-mail:
| | - Václav Klika
- Department of Mathematics, FNSPE, Czech Technical University in Prague, Trojanova 13, Prague 120 00, Czech Republic e-mail:
| | - Habiba Bougherara
- Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada e-mail:
| |
Collapse
|
13
|
Hirata Y, Inaba Y, Kobayashi N, Ike H, Fujimaki H, Saito T. Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis. J Arthroplasty 2013; 28:1731-5. [PMID: 23683518 DOI: 10.1016/j.arth.2013.04.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/12/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023] Open
Abstract
Stress shielding after total hip arthroplasty (THA) remains an unsolved issue. Various patterns of mechanical stress appear according to the type of femoral stem used. To compare differences in mechanical stress conditions between Zweymuller type and fit-and-fill type stems, finite element analysis (FEA) was performed. Differences in bone mineral density (BMD) changes in the femur were also compared. Maximum stress was confirmed in Gruen zone 4, whereas zone 1 had the minimum amount of stress with both types of implant. The Zweymuller stem group had less mechanical stress and lower BMD in zone 7 than the fit-and-fill stem group. In conclusion, differences in mechanical stress may be related to changes in BMD after THA.
Collapse
Affiliation(s)
- Yasuhide Hirata
- Department of Orthopedic Surgery, Yokohama City University, Yokohama, Japan
| | | | | | | | | | | |
Collapse
|
14
|
Yamauchi Y, Jinno T, Koga D, Asou Y, Morita S, Okawa A. Comparison of different distal designs of femoral components and their effects on bone remodeling in 1-stage bilateral total hip arthroplasty. J Arthroplasty 2012; 27:1538-43. [PMID: 22425307 DOI: 10.1016/j.arth.2012.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/29/2012] [Indexed: 02/01/2023] Open
Abstract
To evaluate the effects of distal design of a proximally coated femoral component on periprosthetic bone remodeling, we prospectively performed 21 one-stage bilateral total hip arthroplasties using a distally tapered and a distally cylindrical stem with the same proximal design, randomized to side. All hips showed good outcomes clinically and radiographically at the final follow-up, average of 7 years postoperatively. Cancellous condensation was always found in Gruen's zones 2 and 6 around the cylindrical stem and in regions between zones 2 and 3 and between zones 6 and 5 around the tapered stem. Bone mineral density of Gruen's zones 2 and 6 was significantly lower around the tapered stem. These results suggested more distal loading in hips with the tapered stem than in those with the cylindrical stem.
Collapse
Affiliation(s)
- Yuki Yamauchi
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
15
|
Bone remodelling around a cementless straight THA stem: a prospective dual-energy X-ray absorptiometry study. Hip Int 2012; 22:166-71. [PMID: 22547383 DOI: 10.5301/hip.2012.9227] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2012] [Indexed: 02/04/2023]
Abstract
The design of the Bicontact® stem (BBraun, Aesculap, Tuttlingen, Germany) and the implantation technique have undergone no major alterations in the last 20 years leading, and good clinical results have been reported. The aim of our study was to investigate whether the implant encourages beneficial bone remodelling. Twenty-four patients were included in a prospective dual-energy X-ray absorptiometry (DEXA) study of this stem, after appropriate statistical power analysis. Preoperative and postoperative (1 week, 6 months, and 12 months) clinical and DEXA examinations were performed. The Harris Hip Score increased significantly by 39 points. The strongest decreases in BMD were observed in the greater trochanter region (-11%) and the calcar (-12%). In the second half of the study period the bone mineral density recovered slightly and even returned to baseline values in the lesser trochanter region. Therefore, proximal load transfer and physiological bone remodelling around the Bicontact® stem appeared to be achieved.
Collapse
|
16
|
The cementless Bicontact stem in a prospective dual-energy X-ray absorptiometry study. INTERNATIONAL ORTHOPAEDICS 2012; 36:2211-7. [PMID: 22864457 DOI: 10.1007/s00264-012-1616-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The cementless Bicontact total hip arthroplasty (THA) system (AESCULAP AG, Tuttlingen, Germany) was introduced in 1986/1987 and has been in successful clinical use in an unaltered form up to today. Although good long-term results with the Bicontact stem have been published, it is questionable whether the implant provides the criteria for a state-of-the-art stem regarding proximal bone stock preservation. The purpose of the study was to monitor the periprosthetic bone mineral density (BMD) in a prospective two-year follow-up dual-energy X-ray absorptiometry (DEXA) study. METHODS After power analysis, a consecutive series of 25 patients with unilateral Bicontact stem implantation was examined clinically and underwent DEXA examinations. Scans of seven regions of interest were taken preoperatively and at one week, six months, and one and two years. RESULTS One patient required stem revision due to a deep infection. The Harris Hip Score increased significantly by 44 points. The most significant bone loss was observed in the calcar region (R7) in the first six months (-19.2 %). It recovered in the following 18 months to -8.5 %. The BMD in the greater trochanter dropped significantly after six months and remained stable at this level. BMD exceeded baseline values in distal regions and even more in the lesser trochanter region after two years. CONCLUSIONS We conclude that the Bicontact stem provides adequate proximal bone stock preservation. We observed some signs of stress shielding at the tip of the stem, which is inevitable to some degree in THA with cementless straight stems. However, in this prospective DEXA investigation, we showed that proximal off-loading does not occur after THA with the Bicontact system. Thus, we believe that this stem is still a state-of-the-art implant.
Collapse
|
17
|
Penny JO, Brixen K, Varmarken JE, Ovesen O, Overgaard S. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement. ACTA ACUST UNITED AC 2012; 94:1036-44. [DOI: 10.1302/0301-620x.94b8.28222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient’s resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side.
Collapse
Affiliation(s)
- J. O. Penny
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
| | - K. Brixen
- University of Southern Denmark, Department
of Endocrinology, Odense University Hospital, Sdr.
Boulevard 29, 5000 Odense C, Denmark
| | - J. E. Varmarken
- Naestved Hospital, Department
of Orthopaedic Surgery, Naestved Hospital, Ringstedgade
61, 4700 Naestved, Denmark
| | - O. Ovesen
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
| | - S. Overgaard
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
| |
Collapse
|
18
|
Han CW, Yang IH, Lee HY, Han CD. Long-term follow-up results of a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. Yonsei Med J 2012; 53:186-92. [PMID: 22187251 PMCID: PMC3250326 DOI: 10.3349/ymj.2012.53.1.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. MATERIALS AND METHODS One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. RESULTS The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. CONCLUSION The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.
Collapse
Affiliation(s)
- Chang Wook Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick Hwan Yang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yeon Lee
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Sayyidmousavi A, Bougherara H. Investigation of stress shielding around the Stryker Omnifit and Exeter periprosthetic hip implants using an irreversible thermodynamic-based model. J Biomed Mater Res B Appl Biomater 2011; 100:1416-24. [PMID: 22121059 DOI: 10.1002/jbm.b.32500] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 07/15/2011] [Accepted: 10/20/2011] [Indexed: 11/06/2022]
Abstract
This study investigates stress shielding by predicting bone density around two different implants following total hip arthroplasty using a new thermodynamic-based model for bone remodeling. This model is based on chemical kinetics and irreversible thermodynamics in which bone is treated as a self-organizing system capable of exchanging matter, energy, and entropy with its surroundings. Unlike the previous works in which mechanical loading is regarded as the only stimulus for bone remodeling, this model establishes a coupling between mechanical loading and the chemical reactions involved in the process of bone remodeling. This model is incorporated into the finite element software ANSYS by means of a macro to investigate stress shielding around two different implants: Stryker Omnifit and Exeter periprosthetic hip stems. The results of the simulation showing bone density reductions of 17% in Gruen zone 1 and 27% in Gruen zones 7 around the Omnifit hip stem agree well with dual-energy X-ray absorptiometry (DEXA) measurements reported in the literature. On the other hand, the Exeter implant is found to result in more severe resorption in the proximal femur. This is consistent with clinical studies, which report a higher survivorship rate for HA-coated Omnifit hip stems.
Collapse
Affiliation(s)
- Alireza Sayyidmousavi
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | | |
Collapse
|