Skip to main content

Advertisement

SpringerLink
Log in

Bone remodelling and integration of two different types of short stem: a dual-energy X-ray – absorptiometry study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Different kinds of bone preserving hip stems have been created to assure a more physiological distribution of the strengths on the femur. The aim of this research is to evaluate the density reaction of the periprosthetic bone while changing the conformation of the prosthetic implant on dual-energy X-ray – absorptiometry (DXA).

Methods

This is a prospective, single-centre study assessing bone remodelling changes after implantation of two short hip stems, dividing the patients in two groups according to the implant used: 20 in group A, Metha (B-Braun), and 16 in group B, SMF (Smith and Nephew). All participants had a pre-operative and a post-operative (24 months) DXA evaluating the changes in bone mass density (BMD) occurred in the five Gruen’s zones.

Results

Compared to the pre-operative value, differences in BMD percentage were statistically significant only in ROI 4 (p < 0.05), with an increase in both groups (9 and 18%, respectively). The average increase in BMD was of 7.3% and 7.2% in the 2 groups.

Conclusion

According to our study, both stems have proved able to provide good load distribution across the metaphyseal region favouring proper system integration. Nonetheless, is certainly needed to perform other studies with longer follow-up and bigger populations to give strength to these conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kurtz SM, Lau E, Ong K et al (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467:2606–2612

    Article  Google Scholar 

  2. Van Oldenrijk J, Molleman J, Klaver M, Poolmann RW, Haverkamp D (2014) Revision rate after short-stem total hip arthroplasty: a systematic review of 49 clinical studies. Acta Orthop 85(3):250–258

    Article  Google Scholar 

  3. Falez F, Casella F, Papalia M (2015) Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics 38(3 Suppl):S6–S13

    Article  Google Scholar 

  4. Udomkiat P, Wan Z, Dorr LD (2001) Comparison of preoperative radiographs and intraop- erative findings of fixation of hemispheric porous-coated sockets. J Bone Joint Surg Am 83-A:1865–1870

    Article  Google Scholar 

  5. Phillips NJ, Stockley I, Wilkinson JM (2002) Direct plain radiographic methods versus EBRA-digital for measuring implant migration after total hip arthroplasty. J Arthroplast 17:917–925

    Article  Google Scholar 

  6. Abrahams JM, Kim YS, Callary SA, De Ieso C, Costi K, Howie DW, Solomon LB (2017) The diagnostic performance of radiographic criteria to detect aseptic acetabular component loosening after revision total hip arthroplasty. Bone Joint J 99-B(4):458–464

    Article  CAS  Google Scholar 

  7. Kroger H, Miettinen H, Arnala I, Koski E, Rushton N, Suomalainen O (1996) Evaluation of periprosthetic bone using dual-energy-x-ray absorptiometry: precision of the method and effect of operation on bone mineral density. J Bone Miner Res 11:1526–1530

    Article  CAS  Google Scholar 

  8. Knutsen AR, Lau N, Longjohn DB, Ebramzadeh E, Sangiorgio SN (2017) Periprosthetic femoral bone loss in total hip arthroplasty: systematic analysis of the effect of stem design. Hip Int 27(1):26–34

    Article  Google Scholar 

  9. Rollo G, Bisaccia M, Rinonapoli G, Caraffa A et al (2019) Radiographic, bone densitometry and clinic outcomes assessments in femoral shaft fractures fixed by plating or locking retrograde nail. Mediev Archaeol 73(3):195–200

    Google Scholar 

  10. Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg (Br) 82(7):952–958

    Article  CAS  Google Scholar 

  11. Falez F, Casella F, Panegrossi G, F. Favetti, C. Barresi. (2008) Perspectives on metaphyseal conservative stems. J Orthop Traumatol 9:49–54

  12. Yamaguchi K, Masuhara K, Ogzono K, Sugano N, Nishii T, Ochi T (2000) Evaluation of periprosthetic bone –remodeling after cementless total hip arthroplasty. The influence of the extent of porous coating. J Bone Joint Surg Am 82:1426–1431

    Article  CAS  Google Scholar 

  13. Synder M, Drobniewski M, Pruszczyński B, Sibiński M (2009) Initial experience with short Metha stem implantation. Ortop Traumatol Rehabil 11(4):317–323

    PubMed  Google Scholar 

  14. McCalden RW, Naudie DN, Thompson A, Moore CA (2011) RSA analysis of early migration of the uncemented SMFTM vs SYNERGYTM stem: A prospective randomized controlled trial. Bone Joint Sci 1(2)

  15. Frndak PA, Mallory T, Lombardi A Jr (1993) Translateral surgical approach to the hip. The abductor muscle “split”. Clin Orthop Relat Res 295:135–141

    Google Scholar 

  16. Cohen B, Rushton N (1995) Accuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg (Br) 77(3):479–483

    Article  CAS  Google Scholar 

  17. Albanese CV, Rendine M, De Palma F, Impagliazzo A, Falez F, Postacchini F, Villani C, Passariello R, Santori FS (2006) Bone remodelling in THA: a comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report. Hip Int 16(Suppl 3):9–15

    Article  Google Scholar 

  18. Albanese CV, Santori FS, Pavan L, Learmonth ID, Passariello R (2009) Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems: 37 patients followed for 3 years. Acta Orthop 80(3):291–297. https://doi.org/10.3109/17453670903074467

    Article  PubMed  PubMed Central  Google Scholar 

  19. Garellick G, Rogmark C, Karrholm J, Rolfson O. Swedish Hip Arthroplasty Register: annual report 2012. (2013) Available at: http://www.shpr.se/en/Publications/DocumentsReports.aspx. Accessed June 2016

  20. Pipino F (2006) Tissue-sparing surgery (T.S.S.) in hip and knee arthroplasty. J Orthop Trauma 7:33–35

    Article  Google Scholar 

  21. Gasbarra E, Celi M, Perrone FL et al (2014) Osteointegration of Fitmore stem in total hip arthroplasty. J Clin Densitom 17(2):307–313

    Article  Google Scholar 

  22. Chen HH, Morrey BF, An KN, Luo ZP (2009) Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplast 24(6):945–950

    Article  CAS  Google Scholar 

  23. Erivan R, Muller AS, Villatte G, Millerioux S, Mulliez A, Boisgard S, Descamps S (2019) Short stems reproduce femoral offset better than standard stems in total hip arthroplasty: a case-control study. Int Orthop. https://doi.org/10.1007/s00264-019-04355-5

  24. Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J (2019) Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials. Int Orthop 43(7):1573–1582. https://doi.org/10.1007/s00264-018-4124-3

    Article  PubMed  Google Scholar 

  25. McTighe T, Stulberg SD, Keppler L et al (2018) Classification system for short stem uncemented total hip arthroplasty. Orthop Proc 95-B(SUPP_15)

  26. Feyen H, Shimmin AJ (2014) Is the length of the femoral component important in primary total hip replacement? Bone Joint J 96-B:442–448

    Article  CAS  Google Scholar 

  27. Logroscino G, Ciriello V, D’Antoni E, De Tullio V, Piciocco P, Magliocchetti Lombi G, Santori FS, Albanese CV (2011, 24) Bone integration of new “stemless” hip implants (Proxima vs. Nanos). A dxa study: preliminary results. Int J Immunopatbol Pbarmacol (52):113–116

  28. Molli RG, Lombardi AV Jr, Berend KR, Adams JB, Sneller MA (2012) A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res 470(2):450–461

    Article  Google Scholar 

  29. Parchi PD, Cervi V, Piolanti N et al (2014) Densitometric evaluation of periprosthetic bone remodeling. Clin Cases Miner Bone Metab 11(3):226–231

    PubMed  PubMed Central  Google Scholar 

  30. Panisello JJ, Canales V, Herrero L, Herrera A, Mateo J, Caballero MJ (2009) Changes in periprosthetic bone remodelling after redesigning an anatomic cementless stem. Int Orthop 33(2):373–379

    Article  Google Scholar 

  31. Yamaguchi K, Masuhara K, Yamasaki S, Fuji T (2005) Efficacy of different dosing schedules of etidronate for stress shielding after cementless total hip arthroplasty. J Orthop Sci 10(1):32–36

    Article  CAS  Google Scholar 

  32. Knusten AR, Ebramzadeh E, Longjohn DB, Sangiorgio SN (2014) Systematic analysis of bisphosphonate intervention on peri-prosthetic BMD as a function of stem design. J Arthroplast 29(6):1292–1297

    Article  Google Scholar 

  33. Casella F, Favetti F, Panegrossi G, Papalia M, Falez F (2019) A new classification for proximal femur bone defects in conservative hip arthroplasty revisions. Int Orthop 43(1):63–70. https://doi.org/10.1007/s00264-018-4233-z

    Article  PubMed  Google Scholar 

  34. Pipino F, Keller A (2006) Tissue-sparing surgery: 25 years’ experience with femoral neck preserving hip arthroplasty. J Orthop Traumatol 7(1):36–41

    Article  Google Scholar 

  35. Yan SG, Weber P, Steinbrück A, Hua X, Jansson V, Schmidutz F (2018) Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. Int Orthop 42(9):2077–2086. https://doi.org/10.1007/s00264-017-3691-z

    Article  PubMed  Google Scholar 

  36. von Lewinski G, Floerkemeier T (2015) 10-year experience with short stem total hip arthroplasty. Orthopedics 38(3 Suppl):S51–S56. https://doi.org/10.3928/01477447-20150215-57

    Article  Google Scholar 

  37. Schnurr C, Schellen B, Dargel J, Beckmann J, Eysel P, Steffen R (2017) Low short-stem revision rates: 1−11 year results from 1888 total hip arthroplasties. J Arthroplast 32(2):487–493. https://doi.org/10.1016/j.arth.2016.08.009

    Article  Google Scholar 

  38. Floerkemeier T, Tscheuschner N, Calliess T et al (2012) Cementless short stem hip arthroplasty METHA® as an encouraging option in adults with osteonecrosis of the femoral head. Arch Orthop Trauma Surg 132:1125–1131

    Article  Google Scholar 

  39. Thorey F, Hoefer C, Abdi-Tabari N et al (2013) Clinical results of the metha short hip stem: a perspective for younger patients? Orthop Rev (Pavia) 5:e34

    Article  Google Scholar 

  40. Wittenberg RH, Steffen R, Windhagen H, Bücking P, Wilcke A (2013) Five-year results of a cementless short-hip-stem prosthesis. Orthop Rev (Pavia) 2013(5):e4

    Article  Google Scholar 

  41. Chammaï Y, Brax M (2015) Medium-term comparison of results in obese patients and non-obese hip prostheses with Metha® short stem. Eur J Orthop Surg Traumatol 25:503–508

    Article  Google Scholar 

  42. Lerch M, von der Haar-Tran A, Stukenborg-Colsman CM (2012) Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy x-ray absorptiometry study. Int Orthop 36(3):533–538

    Article  Google Scholar 

  43. Leichtle UG, Lesure J, Martini F, Leichtle CI (2011) Immediate changes of bone density caused by the implantation of a femoral stem a DEXA study. Hip Int 21(06):706–712

    Article  Google Scholar 

  44. Rahmy A, Tonino AJ, Tan W, Ter Riet G (2000) Precision of dual energy X-ray absorptiometry in determining periprosthetic bone minerl density of the hydroxyapatite coated hip prosthesis. Hip International 10:83–90

    Article  Google Scholar 

  45. Epinette JA, Brax M, Chammaï Y (2017) A predictive radiological analysis of short stems versus both shortened and long stems in primary hip replacement: a case-control study of 100 cases of Metha versus ABG II and Omnifit HA at 2-8years' follow-up. Orthop Traumatol Surg Res 103(7):981–986. https://doi.org/10.1016/j.otsr.2017.07.014

    Article  PubMed  Google Scholar 

  46. Wu XD, Chen Y, Wang ZY, Li YJ, Zhu ZL, Tao YZ, Chen H, Cheng Q, Huang W (2018) Comparison of periprosthetic bone remodeling after implantation of anatomic and tapered cementless femoral stems in total hip arthroplasty: a prospective cohort study protocol. Medicine (Baltimore) 97(39):e12560. https://doi.org/10.1097/MD.0000000000012560

    Article  Google Scholar 

  47. Tatani I, Panagopoulos A, Diamantakos I, Sakellaropoulos G, Pantelakis S, Megas P (2019) Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis. Trials 20(1):359. https://doi.org/10.1186/s13063-019-3445-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Parchi PD, Ciapini G, Castellini I, Mannucci C, Nucci AM, Piolanti N, Maffei S, Lisanti M (2017) Evaluation of the effects of the Metha® short stem on periprosthetic bone remodelling in total hip arthroplasties: results at 48 months. Surg Technol Int 30:346–351

    PubMed  Google Scholar 

  49. Ghera S, Pavan L (2009) The DePuy Proxima hip: a short stem for total hip arthroplasty. Early experience and technical considerations. Hip Int 19:215–220

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Via G. Martinotti 20, 00135, Rome, Italy

    F Falez, F Casella, G Mazzotta & F Favetti

  2. Department of Orthopaedics and Traumatology, ASL Roma 1, S. Spirito Hospital, Rome, Italy

    M Papalia

  3. Department of Orthopaedics and Traumatology, “Campus Bio-Medico” University, Rome, Italy

    G Granata

  4. Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

    D Longo

  5. Department of Orthopaedics and Traumatology, Nuova Itor Clinic, Rome, Italy

    A Ciompi

Authors
  1. F Falez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Papalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Granata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Ciompi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G Mazzotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F Favetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F Falez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Falez, F., Papalia, M., Granata, G. et al. Bone remodelling and integration of two different types of short stem: a dual-energy X-ray – absorptiometry study. International Orthopaedics (SICOT) 44, 839–846 (2020). https://doi.org/10.1007/s00264-020-04545-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04545-6

Keywords

Search

Navigation