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Comparative Study
. 2009 Feb;80(1):14-9.
doi: 10.1080/17453670902804802.

Large femoral bone loss after hip revision using the uncemented proximally porous-coated Bi-Metric prosthesis: 22 hips followed for a mean of 6 years

Per Y Adolphson  1 , Mats O F Salemyr, Olof G Sköldenberg, Henrik S G Bodén
Affiliations
Comparative Study

Large femoral bone loss after hip revision using the uncemented proximally porous-coated Bi-Metric prosthesis: 22 hips followed for a mean of 6 years

Per Y Adolphson et al. Acta Orthop. 2009 Feb.

Abstract

Background and purpose: Periprosthetic bone loss after uncemented femoral hip revision is a matter of concern. We have used a proximally porous- and hydroxyapatite-coated prosthesis (Bi-Metric) in revision since 1989 and now we report the bone changes. This prosthesis is intended to distribute the forces more evenly and to avoid proximal femoral unloading.

Methods: 22 patients were unilaterally reoperated because of aseptic loosening. Only patients with a healthy contralateral hip were included. Mean age at revision was 69 (55-80) years. Bone defects were graded by Gustilo-Pasternak and Endo-Klinik classifications. Clinical assessment was performed with Harris hip score. We used radiographs and dual-energy X-ray absorptiometry to evaluate migration, femoral remodeling, and bone mineral density after 72 (30-158) months.

Results: The mean Harris hip score was 74 (30-100) points at follow-up. Mild thigh discomfort was present in 1 patient and moderate thigh pain in 3 patients. There was no loosening or subsidence. Osteolysis seen at revision had diminished in 19 of the 22 hips at follow-up. We noted a large reduction in bone mineral density. It was most pronounced in Gruen regions 1, 2, 6, and 7.

Interpretation: Revision with this stem is a reliable procedure; however, we noted a large degree of proximal bone loss that could lead to later mechanical complications or fractures.

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Figures

Figure 1.
Figure 1.
The proximally hydroxyapatite-coated Bi-Metric modular femoral stem. The prosthesis is tapered in 3 dimensions.
Figure 2.
Figure 2.
Radiographic findings in the different Gruen regions. Linear osteolysis at revision and remodeling after the rearthroplasty.
Figure 3.
Figure 3.
Percentage side difference in BMD in different Gruen regions after the rearthroplasty. Median values (25–75 percentiles) are given. An asterisk indicates a difference between sides (p < 0.05).
See this image and copyright information in PMC

References

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