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. 2021 Nov 12;11(11):2094.
doi: 10.3390/diagnostics11112094.

New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study

Sho Totsuka  1 , Tomofumi Nishino  1 , Ryunosuke Watanabe  1 , Masashi Yamazaki  1 , Hajime Mishima  1
Affiliations

New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study

Sho Totsuka et al. Diagnostics (Basel). .

Abstract

Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.

Keywords: POLARSTEM; digital tomosynthesis; fully hydroxyapatite-coated stem; surrounding bone formation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A 61-year-old female patient after THA using a tapered wedge stem. (a) Plain radiographs one month after THA. (b) The same patient 6 y later. There was cortical hypertrophy at Gruen Zones 3 and 5. (c) DTS (AP view) at the same time as (b). Cortical hypertrophy was observed more clearly. (d) DTS (lateral view) at the same time as (b). Heterogeneous loss of permeability is seen in the cancellous bone distal to the porous coating. THA, total hip arthroplasty; DTS, digital tomosynthesis; AP, anterior–posterior.
Figure 2
Figure 2
An 83-year-old female patient 3 y after THA. (a) DTS (lateral view); there was bone formation surrounding the stem (black arrowheads). (b) Plain radiographs (lateral view) of the same patient as in (a); there was cancellous condensation similar to a reactive line (white arrowheads). THA, total hip arthroplasty; DTS, digital tomosynthesis.
Figure 3
Figure 3
Flow diagram of the study design.
Figure 4
Figure 4
An 81-year-old female patient 3 y after THA. (a) Plain radiographs (lateral view); there was bone formation surrounding the stem (black arrowheads). (b) DTS (lateral view); in the same patient as in (a), bone formation was observed uniformly around the stem from proximal to distal (black arrowheads), and the stem–bone interface is seen more clearly in (b) than in (a). THA, total hip arthroplasty; DTS, digital tomosynthesis.
Figure 5
Figure 5
In both AP and lateral views, the 3 y group had a significantly thicker bone formation than the 1 y group (p < 0.001). AP, anterior–posterior.
See this image and copyright information in PMC

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