Evaluation of Proximal Femoral Bone Mineral Density in Cementless Total Hip Arthroplasty: A 3-Arm Prospective Randomized Controlled Trial.
J Bone Joint Surg Am
; 106(6): 508-516, 2024 Mar 20.
Article
en En
| MEDLINE
| ID: mdl-38113306
ABSTRACT
BACKGROUND:
Femoral stem design affects periprosthetic bone mineral density (BMD), which may impact long-term survival of cementless implants in total hip arthroplasty (THA). The aim of this study was to examine proximal femoral BMD in 3 morphologically different uncemented femoral stem designs to investigate whether any particular design resulted in better preservation of BMD.METHODS:
A total of 119 patients were randomized to receive a proximally coated collarless dual-taper wedge stem, a proximally coated collarless anatomic stem, or a fully coated collarless triple-taper stem. All surgeries were performed via the posterior approach, with mobilization on the day of surgery. Dual x-ray absorptiometry scans (Lunar iDXA, GE Healthcare) assessed BMD across the 7 Gruen zones preoperatively and at 6 weeks and 2 years postoperatively; if available, the native contralateral femur was also assessed as a control. Patient-reported outcomes of pain, function, and health were also assessed at these follow-ups.RESULTS:
Averaged across all stems, BMD increased in zones 1 (2.5%), 2 (17.1%), 3 (13.0%), 5 (10%), and 6 (17.9%) at 2 years. Greater preservation of BMD was measured on the lateral cortex (zone 2) for both the dual-taper wedge and anatomic stems (p = 0.019). The dual-taper wedge stem also demonstrated preservation of BMD in the medial calcar (zone 7), while the anatomic and triple-taper stems declined in this region; however, the difference did not reach significance (p = 0.059). Averaged across all stems, BMD decreased in the mid-diaphysis region, distal to the stem tip (zone 4). All stems performed similarly at the time of final follow-up with respect to the patient-reported outcomes.CONCLUSIONS:
This study demonstrated maintenance of femoral BMD after use of 3 different cementless femoral stem designs, with all achieving excellent improvements in patient-reported outcomes. The stems designed to load the proximal metaphyseal region resulted in higher BMD in that region. No significant stress-shielding was observed; however, longer follow-up is required to elucidate the impact of this finding on implant survivorship. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Artroplastia de Reemplazo de Cadera
/
Prótesis de Cadera
Límite:
Humans
Idioma:
En
Revista:
J Bone Joint Surg Am
Año:
2024
Tipo del documento:
Article
País de afiliación:
Nueva Zelanda
Pais de publicación:
Estados Unidos