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. 2021 Jun 5;22(1):518.
doi: 10.1186/s12891-021-04395-2.

Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry

Christina Enciso Holm  1 , Peter Horstmann  2 , Michala Skovlund Sørensen  2 , Karen Dyreborg  2 , Michael Mørk Petersen  2
Affiliations

Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry

Christina Enciso Holm et al. BMC Musculoskelet Disord. .

Abstract

Background: Limb salvage surgery (LSS) is the preferred method for treatment of patients with sarcomas and to a greater extent also to patients with metastatic bone disease. The aim of the present study was to evaluate the adaptive remodeling of the periprosthetic cortical bone after insertion of a tumor prosthesis with cemented stem.

Methods: A prospective study of 21 patients (F/M = 12/9), mean age 55 years (range 15-81) with metastatic bone disease (n = 9), sarcomas (n = 8) or aggressive benign tumors (n = 4) who underwent bone resection due to a tumor, and reconstruction with a tumor-prosthesis (Zimmer® Segmental 130 mm straight fluted cemented stem with trabecular metal (TM) collars) in the proximal femur (n = 10), distal femur (n = 9) or proximal tibia (n = 2). Measurements of bone mineral density (BMD) (g/cm2) were done postoperatively and after 3, 6, and 12 months using dual-energy X-ray absorptiometry. BMD was measured in 4 regions of interest around the cemented stem and in one region of interest 1 cm proximal from the ankle joint of the affected limb and measurement of the contralateral ankle was used as reference. Repeated measures ANOVA and students paired t-test was used to evaluate BMD changes over time.

Results: At 1-year follow-up, BMD decreased compared to baseline in all four regions of interest with a statistically significant bone loss of 8-15%. The bone loss was most pronounced (14-15%) in the 2 regions of interest closest to the trabecular metal (TM) collar and lowest (8%) adjacent to the tip of the stem.

Conclusion: After 1 year the decrease in bone mineral density of the ankle on the affected limb was 9% and the contralateral ankle was close to baseline, thus suggesting that the periprosthetic bone mineral density changes during follow-up, mainly are caused by stress shielding and immobilization.

Trial registration: The study was approved by the Scientific Ethical Committee of the Capital Region of Denmark (J. No. H-2-2014-105) and the Danish Data Protection Agency (J. No.: 2012-58-00004 ).

Keywords: Bone mass density; Dual-energy X-ray absorptiometry; Stress shielding; Tumor prostheses.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart. Enrollment, follow-up, and data analysis
Fig. 2
Fig. 2
Radiographs of proximal femur tumor arthroplasty, Cemented Zimmer® Segmental stem (left). Radiographs of distal femur arthroplasty, Cemented Zimmer® Segmental stem (middle). Radiographs of proximal tibia arthroplasty, Cemented Zimmer® Segmental stem (right)
None
Fig. 3
Fig. 4
Fig. 4
a. Mean (SE) BMD changes in percent of the 4 ROI in proximal femur. b. Mean (SE) BMD changes in percent of the 4 ROI in proximal tibia. c. Mean (SE) BMD changes in percent of the 4 ROI in distal femur
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References

    1. Hwang JS, Mehta AD, Yoon RS, Beebe KS. From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology. J Orthop Traumatol. 2014;15(2):81–86. doi: 10.1007/s10195-013-0265-8. - DOI - PMC - PubMed
    1. Grimer RJ, Taminiau AM, Cannon SR. Surgical outcomes in osteosarcoma. J Bone Jt Surg - Br Vol. 2002;84(3):395–400. doi: 10.1302/0301-620X.84B3.0840395. - DOI - PubMed
    1. Sørensen MS, Gregersen KG, Grum-Schwensen T, Hovgaard D, Petersen MM. Patient and implant survival following joint replacement because of metastatic bone disease. Acta Orthop. 2013;84:301. doi: 10.3109/17453674.2013.788437. - DOI - PMC - PubMed
    1. Holzer G, Krepler P, Koschat MA, Grampp S, Dominkus M, Kotz R. Bone mineral density in long-term survivors of highly malignant osteosarcoma. J Bone Jt Surg - Br Vol. 2003;85(2):231–237. doi: 10.1302/0301-620X.85B2.13257. - DOI - PubMed
    1. Davis AM, Damani M, White LM, Wunder JS, Griffin AM, Bell RS. Periprosthetic bone remodeling around a prosthesis for distal femoral tumors: longitudinal follow-up. J Arthroplast. 2005;20(2):219–224. doi: 10.1016/j.arth.2004.10.009. - DOI - PubMed