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. 2008 Oct;32(5):589-95.
doi: 10.1007/s00264-007-0389-7. Epub 2007 Jun 20.

Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

Rocco P Pitto  1 , Aknaksha Bhargava, Salil Pandit, Cameron Walker, Jacob T Munro
Affiliations

Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty

Rocco P Pitto et al. Int Orthop. 2008 Oct.

Abstract
in English, French

The aim of this prospective study was to measure bone density changes and to assess adaptive bone remodelling after uncemented total hip arthroplasty with a taper-design femoral component using quantitative computer-tomography-assisted osteodensitometry. This method is able to differentiate cortical and cancellous bone structures. Twenty-seven consecutive patients (29 hips) with degenerative joint disease were enrolled in the study. Serial clinical, radiological and CT-osteodensitometry assessments were performed after the index operation. At the 2-year follow-up, the clinical outcome was rated satisfactory in all hips. The radiological assessment showed signs of osteointegration and stable fixation of all cups and stems. We observed a -17% decrease of cortical bone density and -22% decrease of cancellous bone density in the greater trochanter and femoral neck region. Cortical and cancellous bone density decrease at the level of the lesser trochanter was -9% and respectively -4%. We observed small changes of cortical bone density in the diaphyseal regions; in contrast, cancellous bone density increased (range 6% to 27%) in the diaphyseal regions. Overall, a trend of bone density recovery was observed throughout the follow-up period. Periprosthetic bone density changes at the 2-year follow-up are suggestive of stable osteointegration with proximal femoral diaphysis load transfer and moderate metaphyseal stress-shielding.

Le but de cette étude prospective est de mesurer par scanner et ostéodensitométrie la densité osseuse et le remodelage osseux après prothèse non cimentée. Cette méthode permet de différencier les structures osseuses corticales et spongieuses. 27 patients consécutifs (29 hanches) présentant une coxarthrose ont été inclus dans cette étude qui a comporté une analyse radiologique, scanographique et ostéodensitométrie. Pour toutes les hanches à deux ans de suivi post-opératoire, le devenir clinique de ces patients était satisfaisant. La radiologie montrait des signes d’ostéointégration et de fixation stables dans toutes les cupules et pour toutes les pièces fémorales. Nous avons observé une diminution de 17% de la densité corticale et de 22% de la densité de l’os spongieux au niveau du grand trochanter et au niveau du calcar. Il existe également une diminution de la densité osseuse au niveau du petit trochanter tant sur le plan cortical 9% qu’au niveau de l’os spongieux 4%. Nous avons également observé de petites modifications de la densité osseuse corticale au niveau de la région diaphysaire, a contrario nous avons également mis en évidence une augmentation de la densité osseuse de l’os spongieux à ce niveau (de 6 à 27%). Ces différentes modifications osseuses nous permettent, à deux ans de suivi post-opératoire, de penser que l’ostéointégration proximale des éléments prothétiques entraîne un transfert de charge et un stress-shielding métaphysaire modéré.

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Figures

Fig. 1
Fig. 1
The five regions of interest for the CT-assisted osteodensitometry. Region 1 = greater trocanter and neck of femur; region 2 = lesser trochanter; region 3 = 5 cm above the tip of the stem; region 4 = tip of the stem; region 5 = 2 cm below the tip of the stem
Fig. 2
Fig. 2
Cortical BD changes in the five regions of interest at the 1-year and 2-year follow-up
Fig. 3
Fig. 3
Cancellous BD changes in the five regions of interest at the 1-year and 2-year follow-up
Fig. 4
Fig. 4
BD changes observed in the greater trochanter and femoral neck region (level 1) versus BD changes observed in the regions below the lesser trochanter (rest) for cortical bone at the 1-year and 2-year follow-up
Fig. 5
Fig. 5
BD changes observed in the greater trochanter and femoral neck region (level 1) versus BD changes observed in the regions below the lesser trochanter (rest) for cancellous bone at the 1-year and 2-year follow-up
See this image and copyright information in PMC

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