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Alesi D, Zinno R, Scoppolini Massini M, Barone G, Valente D, Pinelli E, Zaffagnini S, Mirulla AI, Bragonzoni L. Variations in bone mineral density after joint replacement: A systematic review examining different anatomical regions, fixation techniques and implant design. J Exp Orthop 2025; 12:e70187. [PMID: 40401156 PMCID: PMC12092379 DOI: 10.1002/jeo2.70187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/09/2024] [Accepted: 12/11/2024] [Indexed: 05/28/2025] Open
Abstract
Purpose This study aims to evaluate postoperative periprosthetic bone mineral density (BMD) at various time points following joint replacement with different implant designs and fixation techniques. Methods Database search was conducted on MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL for studies analyzing bone remodelling after joint replacement (March 2002-January 2024). Inclusion criteria: English-language articles; total joint replacement; at least two BMD evaluations; observational studies, cross-sectional, prospective, retrospective, randomised controlled trials, and clinical trials. Exclusion criteria: no BMD measurement within one month after surgery; BMD data only expressed as percentage changes or graphs without numerical values; no Gruen zone evaluation for hip replacement; no periprosthetic bone evaluation for knee replacement; pharmacological treatment or comorbidities affecting BMD; revision joint replacements; irrelevant articles; no full text or no original data. Results Sixty-eight articles matched the selection criteria. Fifty-five focused on the hip joint, 12 on the knee, and one on the shoulder. After total hip arthroplasty, the greatest bone resorption occurred in the proximal femur, peaking at 6 months. Cemented implants and tapered stems showed greater bone resorption than cementless implants and anatomical stems. BMD around the acetabular component decreased during the first 6 months but increased in regions subjected to higher loads. In total knee arthroplasty, bone loss occurred in the anterior distal femur and medial tibial plateau, with cemented and posterior-stabilised implants showing greater bone loss than cementless and cruciate-retaining designs. Conclusions The periprosthetic BMD decreases progressively after joint replacement. The fixation technique and implant design influence the extent and pattern of this decline. These factors must be considered during the surgical planning, as they can have long-term implications for bone health and implant longevity. Further research is needed to optimise implant design and surgical techniques to mitigate BMD loss and improve patient outcomes. Level of Evidence Level IV.
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Affiliation(s)
- Domenico Alesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM)University of BolognaBolognaItaly
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Raffaele Zinno
- Department for Life Quality Studies (QUVI)University of BolognaRiminiItaly
| | | | - Giuseppe Barone
- Department for Life Quality Studies (QUVI)University of BolognaRiminiItaly
| | - Davide Valente
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Erika Pinelli
- Department for Life Quality Studies (QUVI)University of BolognaRiminiItaly
| | - Stefano Zaffagnini
- Department of Biomedical and Neuromotor Sciences (DIBINEM)University of BolognaBolognaItaly
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | | | - Laura Bragonzoni
- Department for Life Quality Studies (QUVI)University of BolognaRiminiItaly
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Schwarz GM, Synek A, Senck S, Kandathil SA, Holzleitner M, Trieb K, Huber S, Pahr D, Hofstaetter JG, Hirtler L. Three-Dimensional Osseointegration Patterns of Cementless Femoral Stems: An ex Vivo Study with High-Resolution Imaging and Histological Evaluation. J Bone Joint Surg Am 2024; 106:941-949. [PMID: 38512965 DOI: 10.2106/jbjs.23.00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Osseointegration is essential for the long-term survival of cementless femoral stems and is dependent on periprosthetic bone quality and correct implantation technique. The aim of this study was to evaluate the 3-dimensional long-term fixation patterns of, and bone microarchitecture around, cementless hip stems. METHODS Four specimens with varying degrees of bone quality and fixation characteristics from body donors who had received Alloclassic Zweymüller hip stems during their lifetime (mean time in situ at the time of death: 12.73 years) were evaluated with use of radiographs, high-resolution computed tomography (CT) scans, and hard-tissue histology. The CT voxel size was 85 µm, and the following parameters were calculated: total bone volume, total bone volume fraction, trabecular bone volume, trabecular bone volume fraction, cortical bone volume, cortical bone volume fraction, and cortical thickness. Bone-implant contact and canal fill index values for each Gruen zone of the specimens were calculated with use of histological samples. RESULTS Femoral stems with apparently good cortical contact on clinical radiographs showed higher values for cortical bone volume, trabecular bone volume, and cortical thickness in the high-resolution CT analysis than femoral stems with apparently weak cortical contact on clinical radiographs. Based on the histological evaluation, the mean bone-implant contact ranged from 22.94% to 57.24% and the mean canal fill index ranged from 52.33% to 69.67% among the specimens. CONCLUSIONS This study demonstrated different osseointegration patterns of cementless femoral stems on the basis of radiographs, high-resolution CT scans, and histological evaluation. Femora with high cortical bone volume and cortical thickness were associated with higher canal fill indices, whereas femora with low cortical bone volume and cortical thickness had lower canal fill indices and showed a characteristic corner-anchorage pattern. CLINICAL RELEVANCE Osseointegration patterns and thus the long-term survival of cementless femoral stems are dependent on cortical bone volume and cortical thickness.
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Affiliation(s)
- Gilbert M Schwarz
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Alexander Synek
- Institute for Lightweight Design and Structural Biomechanics, Technical University of Vienna, Austria
| | - Sascha Senck
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Sam A Kandathil
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
| | - Martin Holzleitner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Klemens Trieb
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stephanie Huber
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Dieter Pahr
- Institute for Lightweight Design and Structural Biomechanics, Technical University of Vienna, Austria
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
- 2nd Department, Orthopaedic Hospital Vienna Speising, Vienna, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
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3
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Schoon J, Hesse B, Tucoulou R, Geissler S, Ort M, Duda GN, Perka C, Wassilew GI, Perino G, Rakow A. Synchrotron-based characterization of arthroprosthetic CoCrMo particles in human bone marrow. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:54. [PMID: 35691951 PMCID: PMC9189090 DOI: 10.1007/s10856-022-06675-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Particles released from cobalt-chromium-molybdenum (CoCrMo) alloys are considered common elicitors of chronic inflammatory adverse effects. There is a lack of data demonstrating particle numbers, size distribution and elemental composition of bone marrow resident particles which would allow for implementation of clinically relevant test strategies in bone marrow models at different degrees of exposure. The aim of this study was to investigate metal particle exposure in human periprosthetic bone marrow of three types of arthroplasty implants. Periprosthetic bone marrow sections from eight patients exposed to CoCrMo particles were analyzed via spatially resolved and synchrotron-based nanoscopic X-ray fluorescence imaging. These analyses revealed lognormal particle size distribution patterns predominantly towards the nanoscale. Analyses of particle numbers and normalization to bone marrow volume and bone marrow cell number indicated particle concentrations of up to 1 × 1011 particles/ml bone marrow or 2 × 104 particles/bone marrow cell, respectively. Analyses of elemental ratios of CoCrMo particles showed that particularly the particles' Co content depends on particle size. The obtained data point towards Co release from arthroprosthetic particles in the course of dealloying and degradation processes of larger particles within periprosthetic bone marrow. This is the first study providing data based on metal particle analyses to be used for future in vitro and in vivo studies of possible toxic effects in human bone marrow following exposure to arthroprosthetic CoCrMo particles of different concentration, size, and elemental composition. Graphical abstract.
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Affiliation(s)
- Janosch Schoon
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany.
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Bernhard Hesse
- Xploraytion GmbH, 10625, Berlin, Germany.
- ESRF-The European Synchrotron, 38000, Grenoble, France.
| | - Remi Tucoulou
- ESRF-The European Synchrotron, 38000, Grenoble, France
| | - Sven Geissler
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Melanie Ort
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Georgi I Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Giorgio Perino
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Anastasia Rakow
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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de Waard S, van der Vis J, Venema PAHT, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Short-term success of proximal bone stock preservation in short hip stems: a systematic review of the literature. EFORT Open Rev 2021; 6:1040-1051. [PMID: 34909223 PMCID: PMC8631238 DOI: 10.1302/2058-5241.6.210030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Total hip arthroplasty is performed more frequently in younger patients nowadays, making long-term bone stock preservation an important topic. A mechanism for late implant failure is periprosthetic bone loss, caused by stress shielding around the hip stem due to different load distribution. Short stems are designed to keep the physical loading in the proximal part of the femur to reduce stress shielding. The aim of this review is to give more insight into how short and anatomic stems behave and whether they succeed in preservation of proximal bone stock. A systematic literature search was performed to find all published studies on bone mineral density in short and anatomic hip stems. Results on periprosthetic femoral bone mineral density, measured with dual-energy X-ray absorptiometry (DEXA), were compiled and analysed per Gruen zone in percentual change. A total of 29 studies were included. In short stems, Gruen 1 showed bone loss of 5% after one year (n = 855) and 5% after two years (n = 266). Gruen 7 showed bone loss of 10% after one year and –11% after two years. In anatomic stems, Gruen 1 showed bone loss of 8% after one year (n = 731) and 11% after two years (n = 227). Gruen 7 showed bone loss of 14% after one year and 15% after two years. Short stems are capable of preserving proximal bone stock and have slightly less proximal bone loss in the first years, compared to anatomic stems.
Cite this article: EFORT Open Rev 2021;6:1040-1051. DOI: 10.1302/2058-5241.6.210030
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Affiliation(s)
- Sheryl de Waard
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands.,Academic Medical Centre (AMC), Amsterdam, Netherlands
| | - Jacqueline van der Vis
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Pascale A H T Venema
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Inger N Sierevelt
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | | | - Daniël Haverkamp
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
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5
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Gislason MK, Lupidio F, Jónsson H, Cristofolini L, Esposito L, Bifulco P, Fraldi M, Gargiulo P. Three dimensional bone mineral density changes in the femur over 1 year in primary total hip arthroplasty patients. Clin Biomech (Bristol, Avon) 2020; 78:105092. [PMID: 32590143 DOI: 10.1016/j.clinbiomech.2020.105092] [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: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. METHODS Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. FINDINGS The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. INTERPRETATION The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.
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Affiliation(s)
| | - Francesca Lupidio
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; University of Bologna, Department of Industrial Engineering, Italy
| | - Halldór Jónsson
- Landspitali University Hospital, Department of Orthopaedics, Iceland
| | | | - Luca Esposito
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Bifulco
- University of Naples Federico II, Department of Electrical Engineering and Information Technologies, Italy
| | - Massimiliano Fraldi
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; Department of Science, Landspitali University Hospital, Iceland
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6
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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: 0.2] [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.
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7
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Tsitlakidis S, Vot L, Westhauser F, Jaeger S, Klotz MC. Periprosthetic fracture morphology of a femoral neck prosthesis: An in vitro study. Proc Inst Mech Eng H 2019; 233:1175-1182. [PMID: 31545137 DOI: 10.1177/0954411919877286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Femoral neck prostheses have been developed for the treatment of osteoarthritis in young and active patients. The concept combines a bone-conserving and minimal invasive technique with proximal load transferring by metaphyseal anchoring, which results in a more physiological loading pattern. However, little is known about the morphology of periprosthetic fractures. Thus, the aim of this study was to describe fracture patterns and to determine patient-specific factors favoring periprosthetic fracture. This study was performed as a biomechanical experimental study using 10 fresh frozen femora and 10 Silent-Hip femoral neck implants (DePuy International Ltd., Leeds, UK). In order to simulate physiological loading, a static muscle reconstruction (abductor muscles and iliotibial band) and a dynamic simulation of the gait cycle were applied. During biomechanical testing (50% and 100% of normal weight-bearing), three periprosthetic fractures with two different morphologies occurred. The first pattern corresponds to an abrupt breakaway. The second type was of spiral configuration extending to the diaphyseal region and emerging from an initial fissure. Specimen-specific factors favoring periprosthetic fracture were body mass index and varus angle of the implant. Periprosthetic fractures may extend to the subtrochanteric/diaphyseal region and may be of spiral configuration. According to the finding of this study, body mass index and varus/valgus position of the implant are important factors influencing the risk of periprosthetic fractures. Furthermore, partial weight-bearing as part of the postoperative regimen may be favorable.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Leo Vot
- Laboratory of Biomechanics and Implant Research, Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias C Klotz
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Clinic for Orthopedic & Trauma Surgery, Kepler University Hospital, Linz, Austria
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8
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Tsitlakidis S, Westhauser F, Horsch A, Beckmann N, Bitsch R, Klotz M. Femoral neck prostheses: A systematic analysis of the literature. Orthop Rev (Pavia) 2019; 11:8204. [PMID: 31579193 PMCID: PMC6769360 DOI: 10.4081/or.2019.8204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Primary total hip arthroplasty (THA) is one of the most successful surgical procedures. Considering the demographic change the use of new ultra-short femoral implants has gained importance especially when treating young patients. Main features are bone conservation, metaphyseal anchoring and thus reducing stress shielding by proximal load transferring. The objective of this study is to give an overview over the subject of femoral neck prostheses. A systematic review was conducted. A total number of 27 publications were taken into this systematic review. Over all, just a few follow-up, biomechanical and radiostereometric studies have been conducted in the past. Still no long-term results (>10 years of follow-up) are available. The available mid-term results indicate unsatisfactory survival rates. Aseptic loosening was the most common reason for revision. Valgus angle and good bone mineral density were considered to be crucial for primary stability of femoral neck prostheses. Register data report a very low percentage of femoral neck prostheses in THA with even more diminishing implantation rates. To conclude, further studies are necessary in order to provide evidence-based recommendations. Currently, due to the inhomogeneous and poor data a reasonable and legitimate recommendation cannot be given.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Axel Horsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicholas Beckmann
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi Bitsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Clinic for Orthopedic and Trauma Surgery, Kepler University Hospital, Linz, Austria
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9
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Hussain D, Han SM. Computer-aided osteoporosis detection from DXA imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 173:87-107. [PMID: 31046999 DOI: 10.1016/j.cmpb.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Osteoporosis is a skeletal disease caused by a high rate of bone tissue loss, and it is a major cause of bone fracture. In contemporary society, osteoporosis is more common than cancer and stroke and results in a higher rate of morbidity and mortality in the human population. Osteoporosis can conclusively be diagnosed with dual energy X-ray absorptiometry (DXA). In this study, we propose a computer-aided osteoporosis detection (CAOD) technique that automatically measures bone mineral density (BMD) and generates an osteoporosis report from a DXA scan. METHODS The CAOD model denoise and segments DXA images using a non-local mean filter, Machine learning pixel label random forest respectively, and locates regions of interest with higher accuracy. Pixel label random forest classifies a pixel either bone or soft tissue; then contours are extracted from binary image to locate regions of interest and calculate BMD from bone and soft tissues pixels. Mean standard deviation and correlation coefficients statistical analysis were used to evaluate the consistency and accuracy of BMD measurements. RESULTS During a consistency test of BMD measurements using three consecutive scans from Computerized Imaging Reference Systems' Bona Fide Phantom (CIRS-BFP) for the spine, the CAOD model showed an averaged standard deviation of 0.0029 while the standard deviation from manual measurements on the same data set by three different individuals was recorded as 0.1199. During another correlation study of BMD measurements evaluating real human scan images by the CAOD model versus manual measurement, the model scored a correlation coefficient of R2 = 0.9901 while the CIRS-BFP study scored a correlation coefficient of R2 = 0.9709. CONCLUSIONS The CAOD model increases the preciseness and accuracy of BMD measurements. This CAOD method will help clinicians, untrained DXA operators, and researchers (medical scientists, doctors, and bone researchers) use the DXA system with reliable accuracy and overcome workload challenges. It will also improve osteoporosis diagnosis from DXA systems and increase system performance and value.
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Affiliation(s)
- Dildar Hussain
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University 1732, Yongin 17104, Republic of Korea.
| | - Seung-Moo Han
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University 1732, Yongin 17104, Republic of Korea.
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10
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Jahnke A, Schroeder S, Fonseca Ulloa CA, Ahmed GA, Ishaque BA, Rickert M. Effect of bearing friction torques on the primary stability of press-fit acetabular cups: A novel in vitro method. J Orthop Res 2018; 36:2745-2753. [PMID: 29744927 DOI: 10.1002/jor.24041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
Aseptic loosening is the main reason for revision of total hip arthroplasty, and relative micromotions between cementless acetabular cups and bone play an important role regarding their comparatively high loosening rate. Therefore, the aim of the present study was to analyze the influence of resulting frictional torques on the primary stability of press-fit acetabular cups subjected to two different bearing partners. A cementless press-fit cup was implanted in bone-like foam. Primary stability of the cup was analyzed by determining spatial total, translational, and rotational interface micromotions by means of an eddy current sensor measuring system. Torque transmission into the cup was realized by three synchronous servomotors considering resultant friction torques based on constant friction for ceramic-on-ceramic (CoC: μ = 0.044; max. resultant torque: 1.5 Nm) and for ceramic-on-polyethylene (CoP: μ = 0.063; max. resultant torque: 1.9 Nm) bearing partners. Rotational micromotion of CoC was 8.99 ± 0.85 µm and of CoP 13.39 ± 1.43 µm. Translational micromotion of CoC was 29.93 ± 1.44 μm and of CoP 39.91 ± 2.25 μm. Maximum total relative micromotions were 37.10 ± 1.07 μm for CoC and 51.64 ± 2.18 μm for CoP. Micromotions resulting from CoC were statistically lower than those resulting from CoP (p < 0.05). The described 3D-measuring set-up offers a novel in vitro method of measuring primary stability of acetabular cups. We can therefore conclude, that primary stability of acetabular cup systems can be observed using either the lower friction curve (CoC) or the higher friction curve (CoP). In future studies different cup designs or cup fixation mechanisms may be tested and compared in vitro and assessed prior to implantation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2745-2753, 2018.
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Affiliation(s)
- Alexander Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Carlos A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Gafar A Ahmed
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd A Ishaque
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
| | - Markus Rickert
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
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Zhang X, Sun Y, Xie H, Liu J, Zhao Y, Xu Z. The effect of simvastatin on periprosthetic bone mineral density in the hypercholesterolaemic patients after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 42:59-64. [PMID: 28681228 DOI: 10.1007/s00264-017-3551-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of simvastatin on periprosthetic bone mineral density (BMD) in hypercholesterolaemic patients after total hip arthroplasty. METHODS From January 2012 to December 2015, a total of 42 consecutive hypercholesterolaemic patients with total hip arthroplasty were recruited for this study. The simvastatin group was 21 patients (15 males, 6 females) with average age of 69.4 ± 6.6 years treated with simvastatin for one year post-operatively, and the control group was the other 21 patients (12 males, 9 females) who did not take simvastatin. These parameters of the periprosthetic bone mineral density after total hip arthroplasty were collected by dual energy X-ray absorptiometry(DEXA) one week and three, six, 12 months post-operatively. RESULTS In the control group patients showed significant loss of periprosthetic BMD in ROIs 1, 2, 6, and 7 throughout the study period. The loss of BMD in ROIs 3 and 5 was only significantly observed at three months follow-up and recovered thereafter. There were no significant detected changes of BMD in ROI 4. In the Simvastatin group, the percentage of BMD loss was significantly less (P < 0.05) in ROI 1, 2, 6 and 7 throughout the study period than the control group. The percentage of BMD loss were significant observed in ROI 3 and 5 at three months follow-up, which were also significantly less (P < 0.05) than in the control group. A slight gain of BMD was measured in ROI 4 at 12 months follow-up (1.419%, P < 0.05). CONCLUSION Simvastatin administered for one year post-operatively can effectively prevent periprosthetic bone loss after total hip arthroplasty.
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Affiliation(s)
- Xing Zhang
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China
| | - Yawen Sun
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China
| | - Hua Xie
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China
| | - Jun Liu
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China
| | - Yinbi Zhao
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China
| | - Zhonghua Xu
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, No. 16 South Gate Street, Jintan, Jiangsu, China.
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Khanna R, Kokubo T, Matsushita T, Takadama H. Fabrication of dense α-alumina layer on Ti-6Al-4V alloy hybrid for bearing surfaces of artificial hip joint. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:1229-39. [DOI: 10.1016/j.msec.2016.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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